Is Traditional Chinese Medicine Use Associated with Worse Patient-Reported Outcomes Among Chinese-American Rheumatology Patients?
OBJECTIVE: Chinese-Americans are a fast growing immigrant group with more severe rheumatic disease manifestations than Caucasians and often a strong cultural preference for Traditional Chinese Medicine (TCM). We aimed to examine TCM use patterns and association with patientreported outcomes (PROs) among Chinese-American rheumatology patients. METHODS: Chinese-Americans actively treated for systemic rheumatic diseases were recruited from urban Chinatown rheumatology clinics. Data on sociodemographics, acculturation, clinical factors, and TCM use (11 modalities) were gathered. Self-reported health status was assessed using Patient-Reported Outcome Measurement Information System (PROMIS®) short forms. TCM users and non-users were compared. Factors independently associated with TCM use were identified using multivariable logistic regression. RESULTS: Among 230 participants, median age was 55 (range 20-97), 65% were female, 71% had ≤ high school education, 70% were on Medicaid, 47% lived in the US for ≥20 years, and 22% spoke English fluently. Half used TCM in the past year; these participants had worse selfreported anxiety, depression, fatigue, and ability to participate in social roles and activities compared with non-users. In multivariable analysis, TCM use was associated with belief in TCM, female gender, ≥20 years' US residency, reporting western medicine as ineffective, and shorter rheumatic disease duration. CONCLUSION: Among these Chinese-American rheumatology patients, TCM users had worse PROs in many physical and mental health domains. TCM use may be a proxy for unmet therapeutic needs. Asking about TCM use could help providers identify patients with suboptimal health-related quality of life who may benefit from targeted interventions.
Sun, K; Szymonifka, J; Tian, H; Chang, Y; Leng, JC; Mandl, LA
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