OBJECTIVE Radiographic axial spondyloarthritis (r-axSpA) has a 7-year average diagnostic delay. While the impact of sex or gender on time to diagnosis has been evaluated, the role of social determinants of health remains understudied. We assessed whether time from initial clinical documentation of r-axSpA symptoms to r-axSpA diagnosis (diagnostic delay) varies based on sex, race, ethnicity, or the presence of social needs. METHODS We studied patients with r-axSpA from a tertiary center from 2000 to 2022. The cohort was built with the Observational Health Data Sciences and Informatics (OHDSI) network. For the primary analysis, we assessed the time from back pain/spinal pain to r-axSpA diagnosis and secondarily, the time to r-axSpA from any other r-axSpA -related condition. To estimate differences in diagnostic delay, we employed a parametric survival model, accelerated failure time. RESULTS We included 404 patients (mean age 49, 37% female), with 25.5% identifying as Black, 31.1% as other or unknown race and 14.1% as Hispanic. Patients with a documented social need had a 21% increase in time from back pain to r-axSpA diagnosis (95% CI 0.93, 1.56). In patients with any r-axSpA related condition, time to diagnosis increased similarly by 21% (95% CI 0.92, 1.57). Considering an average time to diagnosis of 34 months, a social need increased time to diagnosis by 7 months. CONCLUSION This study reveals a trend toward diagnostic delay in r-axSpA related to social need, sex, race, and ethnicity. Future studies should focus on referral strategies to enable prompt diagnosis and optimize care.

中文翻译：

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放射学中轴型脊柱关节炎诊断时间的差异。


目的 影像学中轴型脊柱关节炎 （r-axSpA） 的平均诊断延迟时间为 7 年。虽然已经评估了性别或性别对诊断时间的影响，但健康社会决定因素的作用仍未得到充分研究。我们评估了从 r-axSpA 症状的初始临床记录到 r-axSpA 诊断 （诊断延迟） 的时间是否因性别、种族、民族或社会需求的存在而异。方法 我们研究了 2000 年至 2022 年来自三级中心的 r-axSpA 患者。该队列是使用观察性健康数据科学和信息学 （OHDSI） 网络构建的。对于主要分析，我们评估了从背痛/脊髓疼痛到 r-axSpA 诊断的时间，其次，评估了从任何其他 r-axSpA 相关疾病到 r-axSpA 的时间。为了估计诊断延迟的差异，我们采用了参数生存模型，加速失败时间。结果我们纳入了 404 名患者 （平均年龄 49 岁，37% 为女性），其中 25.5% 为黑人，31.1% 为其他或未知种族，14.1% 为西班牙裔。有记录的社交需求患者从背痛到 r-axSpA 诊断的时间增加了 21% （95% CI 0.93， 1.56）。在患有任何 r-axSpA 相关疾病的患者中，诊断时间同样增加了 21% （95% CI 0.92， 1.57）。考虑到平均诊断时间为 34 个月，社交需求使诊断时间增加了 7 个月。结论 本研究揭示了 r-axSpA 诊断延迟的趋势与社会需求、性别、种族和民族有关。未来的研究应侧重于转诊策略，以实现及时诊断和优化护理。