1025: Association Between Rural-urban Clinics and the Management of Adult Rheumatoid Arthritis in the United States

Background/Purpose: Disease modifying anti-rheumatic drugs (DMARDs) improve symptom management and outcomes in rheumatoid arthritis (RA). While residence may influence management strategies and access to care, limited research exists on how rural vs. urban residence affects use of DMARDs and glucocorticoids. This study aimed to determine the association between rural and urban clinics and management of rheumatoid arthritis in the U.S.

Methods: We conducted a retrospective analysis of adults, 18-80 years old, rheumatoid arthritis visits utilizing the 2011-2019 National Ambulatory Medical Care Survey datasets. We compared demographic, clinical, and management factors of adult rheumatoid arthritis visits between rural and urban clinics. SPSS Complex Samples 30.0 for Windows was used to analyze the data to account for the NAMCS complex sample survey design. Chi-square and GLM means tests were performed with two-sided test and p < .05. This study was approved by the Institutional Review Board of the University of North Dakota.

Results: Of the estimated 35 million adult RA visits, 5.4% were in rural clinics. Rural RA visits were less likely to be female (57.9% vs 77.7%, p=.000) and more likely to occur in the Midwest (46.8% vs. 14.1%, p=.002). There was no association between rural-urban clinics and age, race, and insurance.



Rural RA patients were less likely to see a medical specialist (41.7% vs 74.7%, p=.011) and more likely to see their own primary care physician (62.8% vs 22.5%, p=.000). Rural and urban RA patients had a similar number of comorbidities (2.3 vs 2.6, p=.090). However, rural RA patients had higher rates of hypertension (43.9% vs 27.8%, p=.004) and end stage renal disease (10.4% vs 1.4%, p=.006).



Rural and urban patients received similar laboratory tests and health education. Rural RA patients were on more medications than their urban counterparts, (7.2 vs 5.3, p=.031), and had a higher rate of opioid therapy (43.1% vs. 23.2%, p=.020). However, rural and urban RA patients had similar rates of DMARD therapy (49.8% vs 51.5%, p=.841) and glucocorticoids (29.9% vs 34.0%, p=.575).

Conclusion: Rural and urban clinics had similar utilization rates of DMARD therapy and glucocorticoids in adult RA patients, despite rural RA patients being more likely to be managed by primary care physicians and urban patients by medical specialists. However, rural RA patients had higher rates of opioid therapy than their urban counterparts.