Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

• Type of Material: Article
• Authors: William Daniel Soulsby, University of California San Francisco; Nayimisha Balmuri, Hospital for Special Surgery New York; Victoria Cooley, Weill Cornell Medicine; Linda M. Gerber, Weill Cornell Medicine; Erica Lawson, University of California San Francisco; Susan Goodman, Hospital for Special Surgery New York; Karen Onel, Hospital for Special Surgery New York; Bella Mehta, Hospital for Special Surgery New York; Cynthia Manos, Emory University; Sampath Prahalad, Emory University; Kelly Rouster Stevens, Emory University
• Language: English
• Date: 2022-12-01
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12969-022-00676-9
• Title of Journal or Parent Work: Pediatric Rheumatology
• Volume: 20
• Issue: 1
• Start Page: 18
• End Page: 18
• Grant/Funding Information: Dr. Mehta is the recipient of a Kellen Scholar Award supported by the Anna Marie and Stephen Kellen Foundation TKIP program. No outside sources of funding were directly used for this study.
• Keywords: Child; Male; Polyarticular juvenile idiopathic arthritis; Cohort Studies; Child, Preschool; Disease activity; Arthritis, Juvenile; Retrospective Studies; Correlation of Data; Social Determinants of Health; Female; Disability Evaluation; Humans; Social determinants of health; Health disparities
• Research Categories: Biology, Anatomy; Biology, Molecular

Abstract

Background: Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. Methods: In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. Results: One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. Conclusion: High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.