A retrospective study presented at the 2023 AANEM meeting revealed that social determinants of health are linked to poorer treatment outcomes in myasthenia gravis patients, emphasizing the need for identifying and supporting at-risk individuals.
Using medical and pharmacy claims data, 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
Led by Judith Thompson, PharmD, MPH, rare disease population health strategy lead at UCB Pharma, the study looked at 7 different 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 (LAAD) claims that was linked with Socially Determined SDoH indices measured at the level of 5-digit ZIP code.
Coming into the study, patients eligible patients had no MG diagnosis or treatment at baseline, otherwise 12 months before index diagnosis. After a 24-month follow-up after index, 3091 (35.0%) patients received what was considered suboptimal therapy. This was defined as beginning therapy without 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 high-risk (vs low-risk) housing environment index score (OR, 1.17; 95% CI, 1.02-1.35) and high-risk food landscape index score (OR, 1.13; 95% CI, 0.99-1.28) had an elevated risk of suboptimal therapy.
READ MORE:
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 more than one-fourth (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 Public Health highlighted the direct and indirect costs as major concerns for patients with MG who were experiencing SDoH barriers. Compiling data from 38 individuals, the majority of whom were enrolled in public insurance and not employed, the most commonly reported 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. Among other economic concerns, several other direct non-medical expenses were expressed as a major concern by a subgroup of respondents, including the cost of accessible transportation, home modifications, professional caregiving, and childcare.
