Reference
- Tayer-Shifman OE, Green R, Beaton DE, et al. Validity evidence for the use of automated neuropsychologic assessment metrics as a screening tool for cognitive impairment in systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2020 Dec;72(12):1809–1819.
Cumulative Social Disadvantage
A cross-sectional analysis of the National Survey of Children’s Health
By William Daniel Soulsby, MD
Why was this study done? Health disparities in juvenile idiopathic arthritis (JIA) are poorly understood. Existing studies examine social determinants of health as independent risk factors, although we hypothesize increased exposure to social disadvantage may be associated with higher risk. Combined scoring systems have been used to investigate social determinants in diseases, such as hypertension and diabetes. We investigated the role of cumulative social disadvantage on childhood arthritis diagnoses, as well as severity of disease.
What were the study methods? A cross-sectional analysis was performed across four years of the National Survey of Children’s Health (NSCH)—a nationally representative survey examining child health across the U.S. A cumulative social disadvantage score was created on the basis of existing proposed risk factors in JIA, including adverse childhood experiences, poverty, public or lack of insurance, and guardian education. This score was used to analyze the association with childhood arthritis among all survey respondents, as well as moderate-to-severe disease among those with reported arthritis.
What were the key findings? Cumulative social disadvantage was associated with a childhood arthritis diagnosis, highest among those with exposure to all four social variables with an adjusted odds ratio (aOR) of 12.4 (95% confidence interval [95% CI] 2.9–53.3). It was also associated with moderate-to-severe disease, also highest for those with the highest score of 4, with an aOR of 12.4 (95% CI 1.8–82.6).
What were the main conclusions? Cumulative social disadvantage is associated with childhood arthritis diagnoses among a nationally representative sample of U.S. children and associated with increased disease severity, suggesting the presence of a social gradient in childhood arthritis.
What are the implications for patients? Children with increased exposure to social disadvantage may have higher odds of having arthritis and may have higher disease severity.
What are the implications for clinicians? Our findings suggest that implementation of social disadvantage screening in the pediatric rheumatology clinic may have the potential to identify patients at risk for higher disease severity who may benefit from targeted services, such as patient navigation programs and social services.
The study: Soulsby WD, Lawson E, Pantell MS. Cumulative social disadvantage is associated with childhood arthritis: A cross-sectional analysis of the National Survey of Children’s Health. Arthritis Care Res (Hoboken). 2022 Jul 29. Epub ahead of print.
