Racial Implicit Bias, Treatment Recommendations, and Perceived Compliance in the Care of Juvenile Idiopathic Arthritis

Racial implicit bias may contribute to health disparities in juvenile idiopathic arthritis (JIA) outcomes by impacting provider medical decision-making. Our study assessed racial and racial-medical compliance implicit biases of an international pediatric rheumatology community and investigated whether their biases impact treatment recommendations for patients with JIA.

A web-based survey, which included a randomized vignette describing either a White or Black patient with JIA, was sent to pediatric rheumatology providers. Participants were prompted to select the best patient management option and to complete two implicit association tests (IATs): race and race compliance. Student's t-tests or analysis of variance were used to compare IAT D-scores between or across groups; all tests were two-sided with P < 0.05 considered statistically significant. Logistic regression models were used to examine associations for two outcomes of interest: recommendation of either adequate (methotrexate monotherapy) or aggressive (methotrexate and adalimumab combination) treatment with each IAT D-score by each vignette.

Overall, 165 pediatric rheumatologists completed the survey. Providers showed a slight pro-White bias in the race IAT (mean D-score ± SD 0.26 ± 0.5) and race-medical compliance IAT (mean D-score ± SD 0.16 ± 0.43). Although not statistically significant, a one-point increase in IAT D-scores was associated with a lower likelihood that providers would choose aggressive treatment versus adequate treatment in the Black vignette (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.20-1.47; P = 0.23), and a greater likelihood that providers would choose aggressive treatment in the White vignette (OR 4.07, 95% CI 0.74-22.24; P = 0.11).

Implicit bias was not associated with treatment recommendations. Further studies are needed to better evaluate the impact of implicit bias.