Sociocultural and Economic Disparities in Physical Therapy Utilization among Insured Older Adults with Rheumatoid Arthritis.

Abstract

To examine influences of sociocultural and economic determinants on physical therapy utilization for older adults with RA. In these annual cross-sectional analyses between 2012-2016, we accessed Medicare enrollment data and fee-for-service claims. The cohort included Medicare beneficiaries with RA based on three diagnosis codes or two codes plus a disease modifying medication claim. We defined race and ethnicity and dual Medicare/Medicaid coverage (proxy for income) using enrollment data. Adults with a Current Procedural Terminology code for physical therapy evaluation were classified as utilizing physical therapy services. Associations between race and ethnicity and dual coverage and physical therapy utilization were estimated with logistic regression analyses. Potential interactions between race and ethnicity status and dual coverage were tested using interaction terms. Of 106,470 adults with RA (75% female; aged 75.8 ± 7.3 years; 83.9% identified as non-Hispanic White, 8.8% as non-Hispanic Black, 7.2% as Hispanic), 9.6-12.5% used physical therapy in a given year. Non-Hispanic Black (aOR: 0.77, 95% CI: 0.73-0.82) and Hispanic (aOR: 0.92, 95% CI: 0.87-0.98) individuals had lower odds of physical therapy utilization than non-Hispanic White individuals. Adults with dual coverage (lower income) had lower odds of utilization than adults with Medicare only (aOR: 0.44, 95% CI: 0.43-0.46). There were no significant interactions between race and ethnicity status and dual coverage on utilization. We found sociocultural and economic disparities in physical therapy utilization in older adults with RA. To address these disparities, we must identify and address the underlying factors that influence the disparities.