A Multicenter Study of Associations between Area-Level Child Opportunity, Initial Disease Severity and Outcomes among Children with Lupus.

IF 3.7 2区 医学 Q1 RHEUMATOLOGY
Joyce C Chang, Jessica P Liu, Emily A Smitherman, Pooja N Patel, Gabrielle Alonzi, Livie Timmerman, Gabrielle A Morgan, Francesca T deFaria, Laura M Berbert, Edie A Weller, Karen H Costenbader, Mary Beth F Son
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引用次数: 0

Abstract

Objective: Child opportunity encompasses neighborhood resources and conditions that influence healthy childhood development. We determined whether area-level opportunity associates with disease severity or disease control in a geographically and socioeconomically diverse, multi-center cohort of patients with childhood-onset systemic lupus erythematosus (cSLE).

Methods: We linked medical records of patients with cSLE at 3 tertiary centers (2016-2022) to the Child Opportunity Index (COI) 2.0 (29 indicators across education, health and environment, socioeconomics). Primary outcomes included severe initial disease presentation (composite of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) ≥10, intensive care, or dialysis) and acute care (inpatient/emergency) visits. Associations between nationally ranked COI levels and outcomes were estimated using mixed effects models clustered by site, adjusted for age, sex, race and ethnicity, language and insurance status.

Results: Among 538 cSLE patients, living in areas with low vs. very high COI associated with 1.93 higher adjusted odds of severe disease presentation (95% CI [1.05-3.57]) and 2.03 higher adjusted incidence of acute care visits within the first year ([1.29-3.18]). At most recent follow-up, living in low vs. very high COI areas associated with higher disease activity (aβ 1.69 [0.54-2.84]) and lower odds of concurrent achievement of SLEDAI-2K≤4 and ≤7.5 mg/day of prednisone, adjusted for initial disease severity and disease duration (aOR 0.44 [0.22-0.88]).

Conclusion: Structural inequities in area-level child opportunity may contribute to disparities in both cSLE severity and disease control. Tailoring interventions for communities with low levels of child opportunity may improve access to pediatric subspecialty care and cSLE outcomes.

区域儿童机会、初始疾病严重程度和狼疮儿童预后之间关系的多中心研究
目的:儿童机会包括影响儿童健康发展的邻里资源和条件。我们在一个地域和社会经济多样化、多中心的儿童期发病系统性红斑狼疮(cSLE)患者队列中确定区域水平的机会是否与疾病严重程度或疾病控制相关。方法:我们将3个三级医疗中心(2016-2022年)的cSLE患者病历与儿童机会指数(COI) 2.0(包括教育、健康和环境、社会经济学等29个指标)相关联。主要结局包括严重的初始疾病表现(系统性红斑狼疮疾病活动指数(SLEDAI-2K)≥10、重症监护或透析)和急性护理(住院/急诊)就诊。使用按地点聚集的混合效应模型估计全国排名的COI水平与结果之间的关联,并根据年龄、性别、种族和民族、语言和保险状况进行调整。结果:538例cSLE患者中,生活在低COI地区与非常高COI地区相比,第一年出现严重疾病的调整几率高1.93 (95% CI[1.05-3.57]),急性护理就诊的调整发生率高2.03([1.29-3.18])。在最近的随访中,生活在低COI和非常高COI地区与较高的疾病活动性相关(aβ 1.69[0.54-2.84]),并且根据初始疾病严重程度和疾病持续时间调整后,同时达到SLEDAI-2K≤4和≤7.5 mg/天强的松的几率较低(aOR 0.44[0.22-0.88])。结论:地区儿童机会的结构性不平等可能导致cSLE严重程度和疾病控制的差异。针对儿童机会水平低的社区量身定制干预措施可能会改善获得儿科亚专科护理和cSLE结果的机会。
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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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