Racial disparities in rheumatology are about access, not biology

Racial disparities are a persistent problem in healthcare, including rheumatology. Black, Hispanic, and other patients of color tend to have worse outcomes than similar white patients. But don’t blame biology, said Ashira Blazer, MD, MSCI, Assistant Professor of Rheumatology at New York University Langone Medical Center.

“Even though there are differences based on how we all look, race is not a measurable reflection of biology,” Dr. Blazer said. “There’s a mix of cultural differences, health behaviors, interactions with healthcare professionals, neighborhood stress, and socioeconomic factors that track with race. Those are the factors that are affecting outcomes.”

Dr. Blazer will discuss racial disparities in lupus outcomes during the Sunday session Addressing Racial Disparities in Rheumatology, which will be held from 11 a.m. – 12 p.m. ET. The session also will be available on demand for registered meeting participants through March 11, 2022.

The reality is that racial disparities in healthcare, including rheumatology, have more to do with access to care than biological differences between patients, Dr. Blazer said.

“The first thing that needs to change is the mindset of physicians and scientists,” she said. “We need to internalize a different view of what race is before we can tackle it. As a body, we have to change the way we approach this. Race is a social construct, not biology.”

Iris Navarro-Millán, MD, MSPH, Assistant Professor of Medicine at Weill Cornell Medicine and the Hospital for Special Surgery, saw the social construct of race in action when she moved from Puerto Rico to the mainland United States.

“I did not know I was a Black woman until I moved to this country in my late twenties,” she said. “I didn’t know what ‘minority’ meant because I come from a population that is more homogeneous, and subtle racial differences were not as important as here.”

Dr. Navarro-Millán will explore disparities in rheumatoid arthritis during Sunday’s session. Racial disparities are the differences in the composition, the structures, and the availability of healthcare resources and access to care, she said.

“We need to revisit our own assumptions about race and disparities just like we revisit our assumptions when we assess a patient with lupus or RA who presents with clinical manifestations that do not fit our textbook definitions,” Dr. Navarro-Millán said. “We also have to diversify the rheumatology workforce so that we can come up with solutions that apply to the different communities where we all come from, and make it easier for patients to access high-quality of care.”

Diversifying the rheumatology workforce is a slow process. It takes years to train new providers from more diverse backgrounds, Dr. Blazer noted, but it may be possible to bring other professionals to the point of care who are more congruent with patient populations.

Another approach is to improve health literacy in local communities and reduce barriers that make it more difficult to access care. Social determinants of health account for about 80% of outcomes, Dr. Blazer said, and providers who do not address those social factors are not providing appropriate care.

“There is this concept that social determinants of health are not my job because I’m a rheumatologist or an immunologist,” Dr. Blazer said. “But it is these things that really make the difference in whether your patient lives or dies, whether your patient keeps her kidney, whether or not your patient is going to be able to go back to work. If we are really trying to improve the health outcomes of our patients, these social determinants of health are the things we should all be experts in.”