The Influence of Race, Ethnicity and Historical Redlining on Psoriatic Disease Burden and Clinical Outcomes

The study objective was to evaluate the association of neighborhood deprivation and structural barriers with disease burden in racial and ethnic subsets of patients with psoriatic arthritis (PsA).

Patients with PsA in the Rheumatology Informatics System for Effectiveness registry of the American College of Rheumatology with reported race, region, and three or more years of follow-up were evaluated. Demographic factors, disease activity measures, social deprivation defined by the area deprivation index, and therapeutic agents were stratified by race. Subgroup analyses were conducted to examine demographic and clinical characteristics across residential areas graded by the Home Owners' Loan Corporation (HOLC), from "best" (HOLC 1-predominantly White residents) to "hazardous" (HOLC 4 or redlined-predominantly Black residents) based on investment risk.

The cohort included 21,429 predominantly female (57.7%) and obese (56.1% body mass index >30) patients with PsA, with median age of 55 (12.8) years. High social deprivation was prevalent among Black patients (25.7 % vs 2.3% Asian, 12.5% White, and 17.3% other), as was high disease activity (HDA; 40.2% vs 25.8% Asian, 29.6% White, and 33.5% other). Approximately 7% of patients with PsA lived in HOLC-graded districts. Smoking, obesity, high social deprivation, federal insurance, and HDA were more prevalent in patients in HOLC 4 areas compared to HOLC 1 areas. HOLC 4 patients also had longer median [interquartile range] periods of HDA (105.0 [0-690] person-days) and fewer days in remission (1.0 [0-5,457] person-days).

In the United States, Black patients with PsA have prevalent HDA and high social deprivation. Additionally, the enduring effects of structural racism appear to negatively influence PsA disease characteristics of patients living in historically redlined areas.