Pediatric Arthritis Linked to Households with Lower Income, Education

William Soulsby, MD

A nationally representative assessment of the US found juvenile idiopathic arthritis (JIA) is more common in households with lower income, lower education levels, and public insurance or no insurance at all.

In new data presented at the American College of Rheumatology (ACR) 2021 Convergence this weekend, a team of investigators from the University of California San Francisco brought attention to the troubling association between social risks and burdens of arthritis among US children.

Led by William D. Soulsby, MD, a Pediatric Rheumatology Fellow at UCSF, investigators sought to calculate a cumulative social risk score that included patient income, race and ethnicity, education, and adverse childhood event data—and to then observe the association between such scores and arthritis cases derived from the National Survey of Children’s Health (NSCH).

Soulsby and colleagues noted that the impact of social determinants on juvenile idiopathic arthritis-related health is “poorly understood,” while studies observing the impact of poverty and insurance status on such patients has shown some indication of impact.

“Racial disparities exist in JIA, including increased pain and joint damage among Black and Latinx children,” investigators wrote. “Adverse childhood events have been associated with increased odds of childhood arthritis, suggesting an association with chronic stress exposure.”

The team conducted a cross-sectional analysis of 2017-18 data from the NSCH, a survey which focuses on the physical and emotional health of children aged 0 to 17 years old in the US. They gave a score of 1 to each of the following domains when establishing social risk scores:

• Education level of high school or less
• Income level at 0% to 199% of Federal Poverty Level
• Insurance status as public or uninsured
• High adverse childhood event score

Soulsby and colleagues dichotomized the cohort by the presence of reported juvenile arthritis cases then compared outcomes with descriptive statistics. They used univariate and multivariate logistic regression to measure the impact of social risk score on likelihood of JIA diagnosis; age, sex, and race/ethnicity were controlled for the analysis. The team additionally assessed the parent-reported severity of arthritis—ranging from moderate-to-severe to mild—within the cohort of patients with arthritis.

Their patient population included 146 children with current arthritis, generating a population estimate of 199,725 national pediatric patients using survey weights. Families of children with JIA more frequently reported a lower income (40% vs 28%), lower education level (27% vs 15%), greater likelihood of public insurance or being uninsured (40% vs 24%), and greater adverse childhood event scores (P <.001).

Investigators observed through multivariate logistic regression that higher social risk score was predictive of arthritis (P = .009); patients with social risk scores of 3 were nearly 3 times as likely to have JIA (OR, 3.93; P = .002). Though the outcome was not statistically significant, investigators did observe that social risk score predicted increased parent-reported arthritis severity in their child (P = .2).

“In this nationally representative sample, children with arthritis were more likely to come from households with lower income and education level and were more likely to have public insurance or be uninsured, yielding higher social risk scores than their peers without arthritis,” Soulsby and colleagues concluded. “In adjusted analysis, social risk factors predicted increased odds of an arthritis diagnosis.”

The study, “Cumulative Social Disadvantage Predicts an Arthritis Diagnosis: A Cross-sectional Analysis of the National Survey of Children’s Health (NSCH),” was presented at ACR 2021.