Why Do Black SLE Patients Have Lower Medication Adherence than White Patients?

Racial disparities among systemic lupus erythematosus (SLE) patients have been documented, with previous research showing poorer incidence, prevalence, and long-term outcomes among racial minorities compared to white patients. Data have also suggested that black SLE patients have lower medication adherence, which significantly contributes to increased morbidity and mortality. A recent study analyzed racial disparities in SLE medication adherence and possible factors associated with lower medication adherence.

“Patient‐physician relationship and quality of communication have been theorized to contribute to the increased nonadherence among minority patients. Given the frequent racial mismatch between SLE patients and providers, the impact of patient‐provider communication on medication adherence is an area that is highly relevant but understudied,” the researchers explained.

They evaluated data from consecutive SLE patients prescribed medications at an academic lupus clinic between August 2018 and February 2019. Patients self-reported medication adherence; pharmacy refill data were also assessed. To attain high composite adherence, patients had to have high self-reported adherence as well as refill rates. Covariates taken into consideration included patient-provider interaction, patient-reported health status, and clinical factors.

Medication Adherence Lower for Black Patients, Reasons Differ

Final analysis included 121 patients with a median (range) age of 44 (22–72) years; 37% of patients were white, and 63% were black. Most patients (95%) were female. Just over half of the cohort (51%) had at least a college education, while just under half (46%) had private insurance.

The overall high composite adherence rate was 38% but was lower among black patients compared to white patients (30% vs. 51%; P=0.02), with the largest gap observed for patients taking mycophenolate (26% vs. 75%; P=0.01). Factors observed among the low composite adherence group included higher damage scores and patient-reported disease activity scores, as well as more acute care visits.

In black patients, “low composite adherence was associated with perceiving fewer ‘Compassionate respectful’ interactions with providers and worse anxiety and negative affect,” the authors observed. “In contrast, among Caucasians, low composite adherence was only associated with higher SLE medication regimen burden and fibromyalgia pain score.”

The study was published in the July issue of ACR Open Rheumatology.

“Importantly, nonadherence was associated with more acute care utilization, higher patient‐reported SLE activity, and higher SLE damage scores, likely contributing to known racial disparities in outcomes. We also identified important potential areas for intervention to improve adherence, providing evidence in favor of interventions that are tailored to patients’ racial backgrounds,” the researchers concluded.