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Race, Income, and Disease Outcomes in Juvenile Dermatomyositis
Kathryn Phillippi1, Mark Hoeltzel2, Angela Byun Robinson1
1Division of Pediatric Infectious Diseases and Rheumatology, Rainbow Babies and Children's Hospital/Case Medical Center, Cleveland, OH.
Insights
Racial and income disparities impact juvenile dermatomyositis (JDM) outcomes. Minority children and those with lower family income experienced worse physical function and quality of life, highlighting the need to address health inequities in JDM care.
Area of Science:
- Pediatric Rheumatology
- Health Disparities Research
- Clinical Outcomes Analysis
Background:
- Juvenile dermatomyositis (JDM) is a rare autoimmune disease affecting children.
- Understanding socioeconomic and racial factors influencing JDM outcomes is crucial for equitable care.
- Existing research has not fully elucidated the impact of race and income on JDM disease progression and morbidity.
Purpose of the Study:
- To investigate the associations between race, family income, and clinical outcomes in pediatric patients diagnosed with JDM.
- To identify specific disparities in disease activity, physical function, and quality of life based on demographic factors.
- To determine risk factors for severe JDM complications like calcinosis in relation to race and socioeconomic status.
Main Methods:
- Analysis of data from 438 children with JDM in the CARRA Legacy Registry.
- Comparison of clinical outcomes (muscle strength, rash, calcinosis, weakness, physical function, quality of life) stratified by race and annual family income.
- Statistical evaluation of demographic data against disease outcomes and complication markers.
Main Results:
- Minority subjects and those with lower incomes reported worse physical function, disease activity, and quality of life.
- Black children had a higher incidence of calcinosis, a marker of disease morbidity.
- While outcomes differed, no significant disparities were found in time to diagnosis or disease duration across racial groups.
Conclusions:
- Racial minority status and lower family income are linked to increased morbidity and poorer outcomes in JDM.
- Targeted interventions are necessary to mitigate health disparities and improve JDM patient outcomes.
- Further research should explore these associations to inform strategies for equitable JDM management.
Objective:
To determine the relationships among race, income, and disease outcomes in children with juvenile dermatomyositis (JDM).
Study Design:
Data from 438 subjects with JDM enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry were analyzed. Demographic data included age, sex, race, annual family income, and insurance status. Clinical outcomes included muscle strength, presence of rash, calcinosis, weakness, physical function, and quality of life measures. Disease outcomes were compared based on race and income.
Results:
Minority subjects were significantly more likely to have low annual family income and significantly worse scores on measures of physical function, disease activity, and quality of life measures. Subjects with lower annual family income had worse scores on measures of physical function, disease activity, and quality of life scores, as well as weakness. Black subjects were more likely to have calcinosis. Despite these differences in outcome measures, there were no significant differences among the racial groups in time to diagnosis or duration of disease. Using calcinosis as a marker of disease morbidity, black race, annual family income <$50 000 per year, negative antinuclear antibody, and delay in diagnosis >12 months were associated with calcinosis.
Conclusion:
Minority race and lower family income are associated with worse morbidity and outcomes in subjects with JDM. Calcinosis was more common in black subjects. Further studies are needed to examine these associations in more detail, to support efforts to address health disparities in subjects with JDM and improve disease outcomes.