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

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.

Keywords: Disease activity; Health disparities; Polyarticular juvenile idiopathic arthritis; Social determinants of health.

Fig. 1

Box and violin plots demonstrate the distribution of the clinical Juvenile Arthritis Disease Activity Score-10 (cJADAS-10) (left) and Child Health Assessment Questionnaire (CHAQ) (right) scores among pJIA patients in the CARRA Registry at baseline, 6 months, and 12 months from time of diagnosis

Fig. 2

Alluvial diagrams demonstrate the flow of patient clusters by community poverty level, family education level, and insurance status on the Clinical Juvenile Arthritis Disease Activity Score-10 (cJADAS-10) among pJIA patients in the CARRA Registry at baseline (top) and 12 months (bottom)

Fig. 3

Alluvial diagrams demonstrate the flow of patient clusters by community poverty level, family education level, and insurance status on the Child Health Assessment Questionnaire (CHAQ) among pJIA patients in the CARRA Registry at baseline (A - top) and 12 months (B - bottom)

Fig. 4

Adjusted generalized linear mixed effect models* analyzing the effect of community poverty level (< 20% versus ≥20%) on the odds of moderate to severe disease activity by cJADAS-10 score (A - left) and persistent functional disability by CHAQ score (B - right) among pJIA patients in the CARRA Registry. *Models designed with community poverty level as the primary predictor and adjusted for insurance status, race/ethnicity, family education level, age, sex, and RF/CCP status