Is Use of Traditional Chinese Medicine Associated with Non-adherence to Prescribed Western Rheumatic Medications among Chinese-American Patients? A Cross-Sectional Survey

BACKGROUND:

Chinese-Americans are a fast-growing immigrant group with worse rheumatic disease outcomes compared to Caucasians and frequent use of Traditional Chinese Medicine (TCM). Whether TCM use is associated with lower adherence to western rheumatic medications is unknown.

METHODS:

Chinese-Americans actively treated for a systemic rheumatic disease were recruited from two Chinatown clinics. Socio-demographic, TCM use, and clinical data were gathered. Self-reported health status was assessed using Patient-Reported Outcome Measurement Information System (PROMIS®) short forms. Adherence was stratified using the 8-item Morisky Medication Adherence Scale. Factors independently associated with high adherence were identified using multivariable logistic regression.

RESULTS:

Among 230 subjects, median age was 55 (range 20-97), 65% were female, 71% had ≤ high school education, 70% were on Medicaid, and 22% reported English fluency. The most common rheumatic diagnoses were rheumatoid arthritis (41%), systemic lupus erythematosus (17%), and seronegative spondyloarthropathies (15%). Half reported TCM use in the past year, and 28% reported high adherence to western rheumatic medications. In multivariable analysis, high adherence was associated with TCM use (OR 3.96, p<0.001), being married (OR 3.69, p=0.004), medication regimen complexity (OR 1.13, p=0.004), older age (OR 1.06, p<0.001), and was negatively associated with anxiety (OR 0.94, p=0.001).

CONCLUSIONS:

While adherence to western rheumatic medications was low in this cohort, interestingly, it was higher among TCM users compared to non-users. TCM use appears to represent a complementary rather than an alternate approach to disease management for these patients. Future studies should evaluate whether TCM use is associated with better disease outcomes.