Health disparities in juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis (JRA), a group of autoimmune diseases involving chronic inflammation of the joints, can adversely affect health-related quality of life, often into adulthood.

Studies in adults with arthritis suggest that socioeconomic status impacts patient prognosis, but no information is available as to whether this is also true in children. A study published in the June 2006 issue of Arthritis Care & Research examined the relationship between patient health insurance coverage (as an indicator of socioeconomic status) and disease outcomes for children with JRA and found that those on Medicaid had significantly lower health-related quality of life (HRQOL) and higher disability.

Led by Hermine I. Brunner, Janalee Taylor and Murray Passo of the Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio, researchers assessed children with JRA who were seen at the hospital's rheumatology clinic between July 2003 and March 2004. Medicaid coverage (or similar coverage under state programs for low-income families of children with chronic diseases) was considered to be an indicator of low socioeconomic status, while having private insurance was considered to be an indicator of middle to high socioeconomic status. Children were evaluated based on age, disease duration, type of JRA onset, course of the disease, number of joints affected, current disease activity, pain, disability and HRQOL. Health care resource utilization was also assessed based on billing for events such as radiology testing, laboratory testing, clinic visits, and inpatient care.

The findings showed that there was a trend toward a higher number of joints affected by arthritis in the Medicaid group, which comprised 40 (14%) of the 295 children evaluated. They also had somewhat higher disease activity, more pain, and a lower level of well-being than children with private health insurance. In addition, the Medicaid group had higher disability and a lower proportion of children with normal physical function, although they had similar access to health care services compared to the privately insured children. "Similar to results found in studies of other pediatric diseases, the results of this study support the theory that Medicaid status is associated with more disability and lower HRQOL, even in the absence of apparent differences in health care resource utilization," the authors state. They add that these differences are not only statistically significant, but clinically significant as well.

The reasons why insurance status is associated with disability and HRQOL in JRA is not clear, since health care resource utilization did not appear to be affected by the type of health insurance the children were using. The authors hypothesize that non-treatment-related factors such as poverty and non-adherence to prescribed treatments might account in part for the differences seen between the Medicaid versus the privately insured children.

"We believe the current study is the first to document a clinically important association between patient insurance status and disease outcome in JRA," the authors conclude. Further studies are needed to determine the mechanisms that lead to the differences observed in the two groups, and to determine whether access to and utilization of health care resources are truly equitable in patients with different health insurance status.

http://www.interscience.wiley.com/journal/arthritiscare