Understanding why rheumatoid arthritis patient treatment preferences differ by race

Racial disparities in the delivery of health services have been well-documented in patients with arthritis as well as other disorders (1–5). These disparities occur even amongst insured populations with access to care (6, 7). Differences in patient preferences may account for some of the variability in healthcare utilization amongst different racial groups (2, 3). Some data suggest that Black patients with rheumatoid arthritis (RA) are less likely to receive aggressive care compared to White patients (8, 9) and that this difference might be explained in part by patients’ preferences (10). How and why treatment preferences differ by race, however, is not well understood. RA treatment decisions are frequently complex and require multiple trade-offs involving relief of symptoms, long-term reduction in disability, common reversible adverse events, and rare serious complications. In this study, we sought to determine whether Black and White RA patients differ in how they make trade-offs between the specific risks and benefits related to treatment. To quantify how patients evaluate specific treatment risks and benefits, we used conjoint analysis. Conjoint analysis is a well-established method that has been used to elicit patients’ preferences for diverse domains in healthcare including treatment options, cancer screening, and healthcare delivery (11–14). We chose to use this approach, because data generated from a conjoint study can be used to quantify the importance that respondents attach to specific risks and benefits, thereby enabling one to identify the impact of each treatment characteristic on patients’ preferences. Using conjoint analysis, it is therefore possible to determine if a patient’s preference is driven primarily by concerns related to the risk of toxicity or the expectations of benefit.