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
{"title":"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","authors":"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","doi":"10.1002/acr.25523","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Child opportunity encompasses neighborhood resources and conditions that influence healthy childhood development. We determined whether area-level opportunity is associated with disease severity or disease control in a geographically and socioeconomically diverse multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE).</p><p><strong>Methods: </strong>We linked medical records of patients with cSLE at three 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 and adjusted for age, sex, race and ethnicity, language, and insurance status.</p><p><strong>Results: </strong>Among 538 patients with cSLE, living in areas with low versus very high COI was associated with 1.93 times higher adjusted odds of severe disease presentation (95% confidence interval [CI] 1.05-3.57) and 2.03 higher adjusted incidence of acute care visits within the first year (95% CI 1.29-3.18). At the most recent follow-up, living in low versus very high COI areas was associated with higher disease activity (adjusted β 1.69 [95% CI 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 (adjusted odds ratio 0.44 [95% CI 0.22-0.88]).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Multicenter Study of Associations Between Area-Level Child Opportunity, Initial Disease Severity, and Outcomes Among Children with Lupus.\",\"authors\":\"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\",\"doi\":\"10.1002/acr.25523\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Child opportunity encompasses neighborhood resources and conditions that influence healthy childhood development. We determined whether area-level opportunity is associated with disease severity or disease control in a geographically and socioeconomically diverse multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE).</p><p><strong>Methods: </strong>We linked medical records of patients with cSLE at three 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 and adjusted for age, sex, race and ethnicity, language, and insurance status.</p><p><strong>Results: </strong>Among 538 patients with cSLE, living in areas with low versus very high COI was associated with 1.93 times higher adjusted odds of severe disease presentation (95% confidence interval [CI] 1.05-3.57) and 2.03 higher adjusted incidence of acute care visits within the first year (95% CI 1.29-3.18). At the most recent follow-up, living in low versus very high COI areas was associated with higher disease activity (adjusted β 1.69 [95% CI 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 (adjusted odds ratio 0.44 [95% CI 0.22-0.88]).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":8406,\"journal\":{\"name\":\"Arthritis Care & Research\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-03-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthritis Care & Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/acr.25523\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthritis Care & Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/acr.25523","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Multicenter Study of Associations Between Area-Level Child Opportunity, Initial Disease Severity, and Outcomes Among Children with Lupus.
Objective: Child opportunity encompasses neighborhood resources and conditions that influence healthy childhood development. We determined whether area-level opportunity is associated with disease severity or disease control in a geographically and socioeconomically diverse multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE).
Methods: We linked medical records of patients with cSLE at three 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 and adjusted for age, sex, race and ethnicity, language, and insurance status.
Results: Among 538 patients with cSLE, living in areas with low versus very high COI was associated with 1.93 times higher adjusted odds of severe disease presentation (95% confidence interval [CI] 1.05-3.57) and 2.03 higher adjusted incidence of acute care visits within the first year (95% CI 1.29-3.18). At the most recent follow-up, living in low versus very high COI areas was associated with higher disease activity (adjusted β 1.69 [95% CI 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 (adjusted odds ratio 0.44 [95% CI 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.
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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