量化医疗保健不平等对于解决因年龄、性别、种族或族裔以及多发病导致的结果不平衡至关重要。在这项研究中，我们分析了英国英格兰和威尔士全民医疗保健系统内类风湿关节炎患者开始使用生物或靶向合成疾病缓解抗风湿药物 (DMARD) 的差异。国家早期炎症性关节炎审计 (NEIAA) 数据集。我们纳入了 2018 年 5 月 8 日至 2022 年 4 月 30 日期间入组 NEIAA 且拥有 12 个月随访数据的所有类风湿关节炎患者。改良泊松回归用于探索与在初始风湿病评估后 12 个月内开始使用生物和靶向合成 DMARD 相关的因素。评估的因素包括年龄、性别、种族、社会经济状况（多重剥夺指数）、吸烟状况和相关合并症（肺病、心血管疾病、癌症和抑郁症）。 NEIAA 得到了具有类风湿性关节炎生活经验的人士的支持，他们为研究设计和研究结果的解释做出了贡献。NEIAA 中的 6098 名患者有类风湿性关节炎的新诊断和可用的随访数据。平均年龄为 59·2 岁 (SD 14·9)； 3912 名患者 (64·2%) 为女性，2186 名患者 (35·8%) 为男性。 6047 名 (99·2%) 患者有可用的种族数据，其中 5215 名 (86·2%) 为白人，152 名 (2·5%) 为黑人，478 名 (7·9%) 为亚裔，202 名 (3·2%) 为亚洲人。 3%）是混血或其他种族。 6098 名患者中有 508 名 (8·3%) 在 12 个月内开始使用生物和靶向合成 DMARD。 40 岁以下的患者比 65 岁以上的患者更有可能开始使用生物和靶向合成 DMARD（多变量调整风险比 2·41 [95% CI 1·83-3·19]；p<0·0001 ）。与白人相比，亚洲人开始使用生物和靶向合成 DMARD 的可能性较小 (0·52 [0·36-0·76]；p=0·0007)，在对社会经济状况、合并症、基线疾病进行调整后，这种情况持续存在严重程度以及对传统合成 DMARD 的初步反应。这些差异对于亚洲女性来说很明显，但对于亚洲男性来说则不然。黑人比白人更有可能开始使用生物和靶向合成 DMARD（1·54 [1·10-2·16]；p=0·012），在调整基线疾病严重程度和自身抗体状态。在英格兰和威尔士的全民医疗保健系统中，新诊断的类风湿关节炎患者开始使用生物和靶向合成 DMARD 的情况因种族和年龄而异。这项研究证明了提供量身定制的信息并确保服务不足的患者群体公平获得高质量护理的重要性。如果要有效缓解健康差异，就必须重新考虑一刀切的方法。Sandoz UK。版权所有 © 2024 作者。由 Elsevier Ltd 出版。这是一篇采用 CC BY 4.0 许可的开放获取文章。由爱思唯尔有限公司出版。保留所有权利。

Quantifying health-care inequality is essential to addressing the imbalance in outcomes attributable to age, sex, race or ethnicity, and multimorbidity. In this study, we analysed differences in the initiation of biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis within the universal health-care system of England and Wales, UK.An observational cohort study was conducted using the National Early Inflammatory Arthritis Audit (NEIAA) dataset. We included all patients with rheumatoid arthritis who were enrolled in NEIAA between May 8, 2018, and April 30, 2022, and who had 12-month follow-up data available. Modified Poisson regression was used to explore factors associated with the initiation of biological and targeted synthetic DMARDs within 12 months of initial rheumatology assessment. The factors evaluated included age, sex, ethnicity, socioeconomic status (index of multiple deprivation), smoking status, and relevant comorbidities (lung disease, cardiovascular disease, cancer, and depression). NEIAA is supported by people with lived experience of rheumatoid arthritis, who contributed to study design and the interpretation of findings.6098 patients in NEIAA had new diagnoses of rheumatoid arthritis and available follow-up data. The mean age was 59·2 years (SD 14·9); 3912 (64·2%) patients were women and 2186 (35·8%) were men. 6047 (99·2%) patients had available ethnicity data, of whom 5215 (86·2%) were White, 152 (2·5%) were Black, 478 (7·9%) were Asian, and 202 (3·3%) were of mixed or other ethnicities. 508 (8·3%) of 6098 patients initiated biological and targeted synthetic DMARDs within 12 months. Patients younger than 40 years were more likely to be initiated on biological and targeted synthetic DMARDs than individuals older than 65 years (multivariable-adjusted risk ratio 2·41 [95% CI 1·83-3·19]; p<0·0001). Asian individuals were less likely to be initiated on biological and targeted synthetic DMARDs than White individuals (0·52 [0·36-0·76]; p=0·0007), which persisted after adjustment for socioeconomic status, comorbidities, baseline disease severity, and the initial response to conventional synthetic DMARDs. These differences were evident for Asian women but not Asian men. Black individuals were more likely to be initiated on biological and targeted synthetic DMARDs than White individuals (1·54 [1·10-2·16]; p=0·012), which became non-significant after adjusting for baseline disease severity and autoantibody status.The initiation of biological and targeted synthetic DMARDs for patients with newly diagnosed rheumatoid arthritis varies markedly by ethnicity and age in the universal health-care system of England and Wales. This study demonstrates the importance of providing tailored information and ensuring equitable access to high-quality care for underserved patient groups. The one-size-fits-all approach must be reconsidered if health disparities are to be mitigated effectively.Sandoz UK.Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.