Racial Disparities in Health Care: How Spondyloarthritis Affects Black People Differently

Racial disparities in health care may delay treatment for Black people with nr-axSpA.

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Statistically, Black Americans are less likely than other races to have non-radiographic axial spondyloarthritis (nr-axSpA) in the United States, according to the American College of Rheumatology. That said, nr-axSpA affects Black people differently when they do have it. This may stem from racial disparities in health care.

Nr-axSpA is one type of inflammatory arthritis that primarily affects the spine. It falls under an umbrella of arthritis diseases that affect the spine, called spondyloarthritis.

One of the main reasons Black people may experience spondyloarthritis differently may be because their treatment gets delayed. “In Black communities, there may be a longer time to diagnosis for non-radiographic axial spondyloarthritis due to many factors,” says Maggie Cadet, MD, rheumatologist in New York.

Early treatment is essential for nr-axSpA. Without treatment, it can progress and begin to damage the sacroiliac joints. Because of Black people tend to have a longer time to diagnosis, they may start treatment later, putting them at a higher risk of complications. (Learn more about nr-axSpA treatment here.)

The Delay in Diagnosis

One of the reasons for the delayed diagnosis is the genetic component behind nr-axSpA. This inflammatory arthritis is believed to have a hereditary component. The most common gene associated with the disease is the HLA-B27 gene.

However, this gene is more common in white people with AS than Black people with AS. While almost all white people with AS carry the gene, only about half of Black people do. As a result, a physician may not even bother testing for the gene in a Black patient with back pain, says Dr. Cadet.

Weight and Back Pain

“Obesity is one of the conditions that's very prevalent in the Black community, and obesity may lead to low back pain,” says Dr. Cadet. As a result, physicians may mistakenly miss signs of spondyloarthritis if they assume the pain is related to weight. (Find out other causes of back pain here.)

Once again, this can cause a delay in treatment. The physician may focus on weight loss, but the back pain may continue. Not only does this delay diagnosis and treatment, but it may also increase the mistrust between healthcare providers and the Black community.

Nr-axSpA in Black Women

Spondyloarthritis is two to three times more common in men than women, according to the American College of Rheumatology. As a result, Black women with symptoms of axial spondyloarthritis may have an especially difficult time getting an accurate diagnosis.

“It's important for females to also get tested for the HLA-B27 gene and seek the help of rheumatologists if they are experiencing long-standing back pain,” says Dr. Cadet.

Racial Disparities in Health Care

“Now we know that there is cultural disparities in the field of medicine,” says Dr. Cadet. She points to the higher rates of death from chronic diseases—such as heart disease, kidney disease, and diabetes—among Black people.

“Something needs to change. There needs to be more leadership positions for Black physicians, as well as more cultural competency curriculum to help physicians engage with patients and build trust with the patients,” says Dr. Cadet. “That way, they are better to get access to care, diagnostic testing, and treatment.”

Learn more ways that the medical community is addressing cultural disparities in health care here.