Association of Demographic, Economic, and Geographic Factors With Guideline-Concordant Infection Prophylaxis in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.
- 1University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
- 2Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
- 3University of North Carolina Kidney Center, Chapel Hill, NC.
Abstract
Infections are the leading cause of hospitalization and mortality among patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Guidelines recommend Pneumocystis jirovecii pneumonia (PJP) prophylaxis during treatment with cyclophosphamide and/or rituximab, but prophylaxis use is low. We assessed associations of demographic, economic, and geographic factors with receipt of PJP prophylaxis among Medicare beneficiaries with AAV. Retrospective cohort study. Medicare fee-for-service beneficiaries with AAV initiating a new treatment episode involving cyclophosphamide and/or rituximab in 2016-2018. Individual-level demographic and insurance factors and county-level economic, geographic, and health care resource factors. Receipt of PJP prophylaxis, defined as trimethoprim/sulfamethoxazole, dapsone, atovaquone, or inhaled pentamidine overlapping the treatment episode start date or the following 30 days. Log-binomial regression was used to estimate prevalence ratios and 95% confidence intervals (CIs). A likelihood ratio test compared a full model including demographic, economic, geographic, and clinical factors with a reduced model including clinical factors only. Among 4,870 immunosuppressant treatment episodes, PJP prophylaxis was used in 26%. Prophylaxis was less common among females than males (24% vs 30%; adjusted prevalence ratio [aPR], 0.80; 95% CI, 0.70-0.91) and more common among beneficiaries in the Midwest than South (34% vs 24%; aPR, 1.39; 95% CI, 1.12-1.73). Prophylaxis was also less common among beneficiaries from counties with persistent poverty (22% vs 32%; aPR, 0.67; 95% CI, 0.44-1.02). Demographic, economic, and geographic factors improved model fit when added to clinical factors. Claims-based measures may be misclassified, and causal inference is limited. Among Medicare beneficiaries with AAV, sex, region, and county-level poverty were associated with receipt of guideline-recommended PJP prophylaxis. Strategies are needed to improve equitable receipt of infection prophylaxis among highly vulnerable patients with AAV.
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BibTeX
@article{cao2026association,
title = {{Association of Demographic, Economic, and Geographic Factors With Guideline-Concordant Infection Prophylaxis in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.}},
author = {Binxin Cao and Ryan P Hickson and Xinhua Zhao and Sherrie L Aspinall and Vimal K Derebail and Susan L Hogan and Alexa Ehlert and Joshua M Thorpe and Ronald J Falk and Carolyn T Thorpe},
journal = {Kidney medicine},
year = {2026},
month = sep,
doi = {10.1016/j.xkme.2026.101538},
url = {https://europepmc.org/article/MED/42999880},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association of Demographic, Economic, and Geographic Factors With Guideline-Concordant Infection Prophylaxis in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.
AU - Binxin Cao
AU - Ryan P Hickson
AU - Xinhua Zhao
AU - Sherrie L Aspinall
AU - Vimal K Derebail
AU - Susan L Hogan
AU - Alexa Ehlert
AU - Joshua M Thorpe
AU - Ronald J Falk
AU - Carolyn T Thorpe
PY - 2026
DA - 2026/09/17
JO - Kidney medicine
DO - 10.1016/j.xkme.2026.101538
UR - https://europepmc.org/article/MED/42999880
AB - Infections are the leading cause of hospitalization and mortality among patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Guidelines recommend Pneumocystis jirovecii pneumonia (PJP) prophylaxis during treatment with cyclophosphamide and/or rituximab, but prophylaxis use is low. We assessed associations of demographic, economic, and geographic factors with receipt of PJP prophylaxis among Medicare beneficiaries with AAV. Retrospective cohort study. Medicare fee-for-service beneficiaries with AAV initiating a new treatment episode involving cyclophosphamide and/or rituximab in 2016-2018. Individual-level demographic and insurance factors and county-level economic, geographic, and health care resource factors. Receipt of PJP prophylaxis, defined as trimethoprim/sulfamethoxazole, dapsone, atovaquone, or inhaled pentamidine overlapping the treatment episode start date or the following 30 days. Log-binomial regression was used to estimate prevalence ratios and 95% confidence intervals (CIs). A likelihood ratio test compared a full model including demographic, economic, geographic, and clinical factors with a reduced model including clinical factors only. Among 4,870 immunosuppressant treatment episodes, PJP prophylaxis was used in 26%. Prophylaxis was less common among females than males (24% vs 30%; adjusted prevalence ratio [aPR], 0.80; 95% CI, 0.70-0.91) and more common among beneficiaries in the Midwest than South (34% vs 24%; aPR, 1.39; 95% CI, 1.12-1.73). Prophylaxis was also less common among beneficiaries from counties with persistent poverty (22% vs 32%; aPR, 0.67; 95% CI, 0.44-1.02). Demographic, economic, and geographic factors improved model fit when added to clinical factors. Claims-based measures may be misclassified, and causal inference is limited. Among Medicare beneficiaries with AAV, sex, region, and county-level poverty were associated with receipt of guideline-recommended PJP prophylaxis. Strategies are needed to improve equitable receipt of infection prophylaxis among highly vulnerable patients with AAV.
SN - 2590-0595
ER -