A retrospective study presented at the 2023 American Association of Neuromuscular and Electrodiagnotsic Medicine meeting revealed that social determinants of health (SDOH) are linked to poorer treatment outcomes in patients who have myasthenia gravis, emphasizing the need for identifying and supporting at-risk individuals.
This article was originally published by Neurology Live®. This version has been lightly edited.
Judith Thompson, PharmD, MPH | Image Credit: UCB Pharma
Using medical and pharmacy claims, data from a retrospective observational study showed that social determinants of health (SDOH) are associated with poorer treatment among patients with myasthenia gravis (MG). Presented at the 2023 American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) annual meeting, held November 1-4, in Phoenix, Arizona, investigators concluded that providers may need to identify patients from at-risk communities who may require additional support.1
Led by Judith Thompson, PharmD, MPH, rare disease population health strategy lead at UCB Pharma, the study looked at 7 SDOH risk indices and their association with suboptimal therapy response in a cohort of 8839 patients with MG. Conducted between October 2018 and September 2020, the analysis used data from IQVIA Longitudinal Access and Adjundication Data claims that were linked with Socially Determined SDOH indices measured via ZIP code.
Coming into the study, eligible patients had no MG diagnosis or treatment at baseline; otherwise, 12 months before index diagnosis. After a 24-month follow-up after their index visit, 35.0% of patients received what was considered suboptimal therapy. This was defined as initiating therapy without an acetylcholinesterase inhibitor, at least 10 mg/day of corticosteroids for 6 months, at least 300 mg/day of azathioprine for 24 months, or at least 3000 mg/day of mycophenolate for 12 months.
Comparing those with and without suboptimal treatment, individuals who received worse treatment were more likely to be male (52.9% vs 46.0%; P < .01), to have fewer comorbidities (Charlson Index, 0.41 vs 0.46; P < .01), and to initiate treatment within 30 days of index (64.6% vs 47.7%; P < .001). After adjustment, regions with a high-risk vs low-risk housing environment index score and high-risk food landscape index score were shown to have elevated risks of suboptimal therapy, at 17% (OR, 1.17; 95% CI, 1.02-1.35) and 13% (OR, 1.13; 95% CI, 0.99-1.28), respectively.
Despite improvements in symptomatic therapies, individuals with MG continue to experience a high burden of disease, with up to 20% experiencing a myasthenic crisis requiring intensive care and respiratory support of their lifetime. Many patients experience issues with performing daily activities, including keeping a stable job. In 2017, a cross-sectional study found that 27.2% of patients (n = 917) had experienced unemployment, 4.1% had been unwillingly transferred, and 35.9% had experienced a decrease in income, 47.1% of whom reported that the decrease was more than 50% of their previous total income.2
More recently, a study published in Frontiers in Public Health highlighted direct and indirect costs as major concerns for patients with MG who were experiencing SDOH. Compiling data from 38 individuals, most of whom were enrolled in public insurance and not employed, the most common major economic concerns were for managing funds for emergency care (66%), loss of income (61%), and nonmedical expenses (58%), highlighting the diversity of economic challenges.3
A broader concern of managing everyday finances and budgets was a major concern for 50% of respondents, with 79% concerned to any extent. In addition, several other direct nonmedical expenses were expressed as major concerns by a subgroup of respondents, including the cost of accessible transportation, home modifications, professional caregiving, and childcare.
References
1. Thompson J, Zhang B, Liberman JN, Darer J. Social determinants of health are associated with suboptimal treatment among individuals with myasthenia gravis. Presented at: 2023 AANEM Annual Meeting; November 1-4; Phoenix, Arizona. Poster 42.
2. Nagane Y, Murai H, Imai T, et al. Social disadvantages associated with myasthenia gravis and its treatment: a multicentre cross-sectional study. BMJ Open. 2017;7(2):e013278. doi:10.1136/bmjopen-2016-013278
3. Hughers T, Howard JF, Silvestri NJ, et al. The economic burden of individuals living with generalized myasthenia gravis and facing social determinants of health challenges. Front Public Health. 2023;11:1247931. doi:10.3389/fpubh.2023.1247931
