Disparities in Dermatomyositis Management Based on Insurance Coverage

Abstract

Dermatomyositis (DM) is a complex, systemic connective tissue disease that requires prompt management and therapy. Previous studies have shown that public insurance enrollees utilize outpatient care less frequently, potentially leading to delayed care and increased disease severity. This retrospective study evaluated the relationship between insurance coverage, healthcare utilization, and therapeutic management in DM patients seen at the University of California Irvine Medical Center between January 2016 and June 2024. We identified 118 cases of adult-onset DM in which 41.6% (49/118) were privately insured, 33.1% (39/118) were enrolled in Medicare, and 25.4% (30/118) with Medicaid. Medicaid enrollees had significantly higher rates of emergent care and hospitalizations (p<0.001) and required sooner intravenous immunoglobulin (IVIg) and rituximab (RTX) (p=0.03). They also trialed fewer systemic agents prior to infusion therapy (IVIg p=0.02, RTX p=0.04). Medicare patients exhibited patterns more similar to those with private insurance. Though there were higher rates of Hispanic patients in the Medicaid cohort (p < 0.001), our results were independent of race/ethnicity. These findings suggest that barriers to outpatient care amongst Medicaid patients may lead to delays in disease recognition, resulting in increased reliance on emergent care and more rapid escalation to aggressive treatments. This study underscores the need for reform to promote equitable and timely care for all patients, particularly imperative in systemic diseases such as dermatomyositis.