Disparities among children with juvenile rheumatoid arthritis

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Public release date: 26-May-2006

Disparities among children with juvenile rheumatoid arthritis

Study finds poorer outcomes in medicaid compared to privately insured

children

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

arthritiscare) 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 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.eurekalert.org/pub_releases/2006-05/jws-dac052406.php