Racial Disparities in Acute Care Utilization Seen Among Patients With Myasthenia Gravis

NeurologyLive® first published this article. This version has been lightly edited.

Findings of a new retrospective cohort study reveal significant differences in acute care utilization, including emergency department (ED) visits and hospitalizations, among different racial subgroups of patients with myasthenia gravis (MG).¹ These findings highlight the need to identify and address factors that contribute to these disparities and to ensure that all patients receive equitable and effective treatment.

Among 7058 patients with MG, investigators observed significant differences among racial subgroups in age, gender, geographic region, insurance status, and rates of hyperlipidemia, thyroid-related disorders, gastroesophageal reflux disease, anxiety, depression, and thymoma. After adjusting for baseline characteristics using a multivariable model, non-Hispanic Black patients had 37% greater odds of experiencing an ED visit compared with non-Hispanic Caucasian patients (P = .04) in year 1. Nobably, Hispanic patients had 70% greater odds of hospitalization compared with non-Hispanic Caucasian patients (P = .04) in year 2.

"This study provided evidence of potential racial disparities in care among those with MG, but further research is needed to characterize factors related to increased acute care utilization," senior author Glenn Phillips, PhD, the senior director of Health Economics & Outcomes Research at Argenx, and colleagues wrote.¹ "Our findings also indicate that certain factors may be important early after diagnosis, while others may not. Acute care events represent a high burden for payers, hospitals, and, most importantly, patients. Patient support programs targeted towards at-risk populations may have the potential to improve disease management and reduce acute care utilization."

Presented at the American Association of Neuromuscular & Electrodiagnostic Medicine meeting, held November 1-4, in Phoenix, Arizona, this study used Optum’s deidentified Market Clarity Data from 2010 to 2019 to evaluate acute care utilization, including ED visits and hospitalizations, in patients with newly diagnosed MG. Using multivariable logistic regression models, investigators assessed differences in outcomes in years 1 and year 2 post diagnosis between racial subgroups, which included patients who identified as non-Hispanic Caucasian, Black and Asian, and Hispanic.

In a previous retrospective analysis published in 2015, findings demonstrate the existence of ethnicity-based differences in clinical and laboratory features of MG.² Forty-four patients were included: 19 Hispanic, 16 African American, 6 Caucasian, and 3 of Asian ethnicity. Results showed that anti–acetylcholine receptor antibody subtypes had no significant ethnicity-based differences regardless of either generalized or occular MG.

Additional findings from that analysis show a trend toward greater frequency of blocking antibodies among Hispanic patients (52.6%) compared with African American (37.5%) and Caucasian (33.3%) patients (P = .059). Generalized but not ocular MG in patients showed a greater frequency of antimuscle-specific kinase antibodies among Asian and Hispanic patients compared with those of African American and Caucasian descent (P = .041). The researchers noted that further investigations of genetic factors that influence clinical features of MG are important to enhance understanding of the disease.

References
1. Qi C, Anderson A, Gelinas D, et al. Racial disparities in acute care utilization outcomes among those with myasthenia gravis. Presented at: American Association of Neuromuscular & Electrodiagnostic Medicine meeting; November 1-4, 2023; Phoenix, Arizona. Abstract 25.

2. Abukhalil F, Mehta B, Saito E, Mehta S, McMurtray A. Gender and ethnicity based differences in clinical and laboratory features of myasthenia gravis. Autoimmune Dis. 2015;2015:197893. doi:10.1155/2015/197893