Method:
Data from 163 African-American (AA) and 180 white (WH) SLE patients recruited from two university clinics were evaluated. Structured interviews and chart reviews were conducted to determine socio-demographic characteristics, clinical factors, perceptions of medications and disease, and beliefs and attitudes towards providers and the healthcare system. Logistic regression models were performed to evaluate the relationship between patient preferences and race, adjusted for patient characteristics.
Result:
AAs, compared to WHs, were less likely to have higher income (p<0.001) and have private insurance (p<0.001). Among patients who had never received CYC (n=293), 62.9% AAs, compared to 87.6% WHs, were willing to receive the medication (p<0.001). This difference persisted (OR 0.37 [95% CI, 0.16-0.87]) after adjusting for socio-demographic variables, clinical characteristics, and perceptions about CYC and physicians. Income ($30001-50000 vs. <$10000, OR 4.07 [95% CI, 1.15-14.33]; >$50000 vs. <$10000, OR 4.45 [95% CI, 1.24-15.97]) and higher perception of CYC effectiveness (OR 1.41 [95% CI, 1.25-1.59]) were other significant determinants of willingness to receive CYC in the adjusted model.
Among patients who had never participated in a RCT (n=326), 64.9% AAs, compared to 84.3% WHs were willing to do so (p<0.001). This difference persisted (OR 0.41 [95% CI, 0.20-0.83]) after adjusting for socio-demographics, clinical context and patients’ perceptions of physicians. SLE damage score (4 vs. 0, OR 0.23 [95% CI, 0.07-0.74]), number of immunosuppressive medications (1 vs. 0, OR 3.65 [95% CI, 1.14-11.73]; ≥2 vs. 0, OR 5.45 [95% CI, 1.62-18.30]) and higher trust in physicians (OR 1.04 [95% CI, 1.00-1.08]) were also independently associated with willingness to participate in a RCT in the adjusted model.
Conclusion:
Variations in lupus patients’ treatment preferences are associated with income, medication history, medication efficacy expectations and trust in physicians. Race remains an independent determinant of preferences after adjusting for these variables. While some factors related to racial differences in patient preferences are relatively fixed, other factors that may alleviate these differences exist, including medication beliefs and trust in providers.