UNDERSTANDING WHY TREATMENT PREFERENCES DIFFER BY RACE

Purpose: Patients' preferences may account for some of the variability in healthcare utilization amongst different racial groups. Further research is needed to understand how and why patient treatment preferences differ by race. We sought to determine whether African American and Caucasian patients differ in how they evaluate the specific risks and benefits related to drugs for rheumatoid arthritis (RA).

Methods: 136 consecutive RA patients recruited from rheumatology clinics completed an interactive computer survey capable of quantifying the importance that patients attach to specific medication characteristics. We included 10 characteristics: benefits (chance of remission, symptom improvement, and radiographic progression), route of administration, and risks (injection reaction, nausea, lung or liver injury, tuberculosis, neurological disease, and theoretical risk of cancer). We created a variable representing the ratio of the importance that patients attached to overall benefit versus overall risk. Subjects having a risk ratio < 1 were classified as risk averse. The relation of risk aversion to each covariate was assessed using chi-square or Mann-Whitney U tests for categorical and continuous variables respectively.

Results: The mean age of the study sample was 55 years (range 22-84), 49% were African American and 51% were Caucasian. African American subjects were most influenced by the risk of cancer (relative importance of 13%), whereas Caucasian subjects were most influenced by the likelihood of remission and radiographic progression (relative importance of 15%). African American subjects were more concerned about the risks of toxicity, whereas Caucasian subjects assigned greater importance to the likelihood of benefit (Figure 1). Fifty-two percent of African American subjects were found to be risk averse compared to 12% of the Caucasian subjects (p<0.0001). Race remained strongly associated with risk aversion [adjusted odds ratio (95% CI) = 8.4 (3.1 - 23.1)] after adjusting for sociodemographic and clinical characteristics.

Conclusions: African American patients attach greater importance to the risks of toxicity (particularly for serious, albeit rare, adverse events) and less importance to the likelihood of benefit than their Caucasian counterparts. Effective risk communication and improved understanding of expected benefits may help decrease unwanted variability in the care of RA.