3062 — Racial Disparities in Treatment Preferences among Lupus Patients in an Urban Academic Center
Vina ER, VA Pittsburgh Healthcare System; Masi CM, Green SL, and Utset TO, University of Chicago Medical Center;
To determine whether there are differences between African American and white Systemic Lupus Erythematosus (SLE) patients’ willingness to a) receive an immunosuppressive medication (cyclophosphamide, CTX), and b) participate in clinical trials involving novel, experimental medications. To determine whether demographic, psychosocial and clinical characteristics explain racial differences in either measure of medical management.
Data from 120 African American and 62 white lupus patients were evaluated. Structured telephone interviews were conducted to determine treatment preferences, and characteristics and beliefs that may affect preferences. Chart reviews were conducted to evaluate clinical characteristics. Serial hierarchical multivariate logistic regression analyses were performed; their deviances from a saturated model were calculated.
Compared to white SLE patients, African American SLE patients were less willing to receive CTX (84.9% vs. 67.0%, p = 0.001). Lupus patients willing to receive CTX were more likely to have private insurance (p = 0.026), be married (p = 0.011) and perceive CTX to be effective (p <0.001) and low risk (p = 0.049). Multivariate logistic regression showed that white race (OR = 3.50, p = 0.017), physician trust (OR = 1.05, p = 0.071) and perception of treatment effectiveness (OR = 1.40, p <0.005) were significant predictors of willingness to receive CTX. After adjustment for socioeconomic variables, the effect of race on willingness to receive CTX was no longer significant (OR = 1.69, 95% CI 0.62-4.65). In contrast, racial differences were observed in willingness to participate in a clinical trial but did not reach statistical significance (80.7% whites vs. 68.7% African-Americans, p = 0.096). A logistic regression model showed that internal health locus of control (OR = 0.92, p = 0.022), physician participatory decision-making style (OR 1.03, p <0.005), lack of physician race preference (OR = 2.28, p = 0.002), marital status (OR = 128.5, p = 0.012), and interaction between marital status and physician race preference (OR = 0.39, p = 0.030) were significant predictors of willingness to participate.
African American and white SLE patients did not differ in willingness to participate in a clinical trial. However, we found a decreased likelihood of accepting CTX in African American compared to white lupus patients. After controlling for socioeconomic factors, this racial disparity was no longer significant.
Willingness to receive CTX was also associated with belief in its efficacy and trust in physicians, suggesting that education and improved trust can influence decision-making among SLE patients.