Exploring Disparate Access to Care in Sarcoidosis Patients in Detroit, Michigan

Document Type

Conference Proceeding

Publication Date

5-21-2024

Publication Title

Am J Respir Crit Care Med

Abstract

Rationale Sarcoidosis is a multisystem granulomatous inflammatory disease with immense ongoing research. Previous studies assessed the role of social predictors on severity at presentation and found Black, older individuals, with lower income, without insurance to have more severe disease. The city of Detroit, Michigan is at greater risk of disparities with 5 times greater Black population and almost thrice in poverty compared to the nation. We aimed to explore these potential disparities to incorporate our findings into future practice at provider, patient and healthcare system level. Methods This is a retrospective chart review study of all patients seen in pulmonary clinics at Henry Ford Health between January 1st, 2020, and December 31st, 2022, with sarcoidosis patients identified as those with ICD diagnosis code D86. Data collected included date of office visit(s), age, race (Black, White, Other), sex, area deprivation index (ADI), insurance type (Medicare, Medicaid, Commercial), MyChart status, chest x-rays, pulmonary function tests (PFTs), missed clinic visits, number of hospitalizations, mortality, positive biopsy on file, communication of results after bronchoscopy and visits around the time of bronchoscopy. Categorical variables were described using frequency. Numerical variables were described using median, mean and standard deviation. Statistical analysis included Chi-square test, Two-sample T-test and Wilcoxon Rank Sum test and a p-value of <0.05 was considered statistically significant. Results Sarcoidosis patients (N=788), when compared to those seen for other pulmonary problems (N=13,036) were typically slightly younger, Black, female, belonging to higher ADI (greater socioeconomic disadvantage) based on national and state ranks, more likely to use commercial insurance and Medicaid compared to Medicare, have active MyChart access, more noshows, more PFTs on file. Among sarcoidosis patients, significant findings included presence of active MyChart among younger patients, lower ADI and with commercial insurance; more X-rays and PFTs were done in Medicare patients; no-show rate was higher in higher ADI; hospitalizations were higher in those with government insurance. Sarcoidosis patients with positive biopsies on file from 2013-2023 were more likely to be male, White or other races, younger and belonged to lower national ADI ranks. Conclusions This study identified an intricate pattern of demographic and socioeconomic variables affecting access to care in sarcoidosis patients, raising concerns for healthcare barriers especially based on race and ADI, and higher bronchoscopies in those demographic groups thought less likely to have sarcoidosis. Understanding these is vital for equitable high-quality care, assisting in timely and efficient management of the patient's disease. (Figure Presented).

Volume

209

Issue

9

First Page

A6720

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