Race, Income, and Disease Outcomes in Juvenile Dermatomyositis

Kathryn Phillippi, Mark Hoeltzel, Angela Byun Robinson, Susan Kim, Leslie S. Abramson, Eleanor S. Anderson, Mara L. Becker, Heather Benham, Timothy Beukelman, Peter R. Blier, Hermine I. Brunner, Joni Dean, Fatma Dedeoglu, Brian M. Feldman, Polly I. Ferguson, Donald P. Goldsmith, Beth S. Gottlieb, Thomas B. Graham, Thomas A. Griffin, Hilary M. HaftelGloria C. Higgins, J. R. Hollister, Joyce J. Hsu, Anna Huttenlocher, Norman T. Ilowite, Lisa F. Imundo, Rita S. Jerath, Lawrence K. Jung, Philip J. Kahn, Daniel J. Kingsbury, Kristin E. Klein, Marisa S. Klein-Gitelman, Sivia K. Lapidus, Thomas J.A. Lehman, Carol B. Lindsley, Michael A. Malloy, Deborah K. McCurdy, Eyal Muscal, Judyann C. Olson, Kathleen M. O'Neil, Karen Onel, Sampath Prahalad, Marilynn G. Punaro, C. Egla Rabinovich, Ann M. Reed, Sarah Ringold, Mary Ellen Riordan, Angela B. Robinson, Deborah Rothman, Natasha M. Ruth, Kenneth N. Schikler, Nora G. Singer, Steven Spalding, Reema H. Syed, Kathryn S. Torok, Jenna Tress, Richard K. Vehe, Emily Von Scheven, Lydia M. Walters, Jennifer E. Weiss, Pamela Weiss, Andrew J. White, Jennifer M. Woo, Ali Yalcindag, Lawrence S. Zemel

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

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 <$50000 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.

Original languageEnglish (US)
Pages (from-to)38-44.e1
JournalJournal of Pediatrics
Volume184
DOIs
StatePublished - May 2017

Bibliographical note

Funding Information:
K.P. receives support from the National Institutes of Health (NIH) under Ruth L. Kirschstein National Research Service Award T32 AR007505 from the NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The CARRA Legacy Registry is supported by the NIAMS (Grant RC2AR058934), Friends of CARRA, the Arthritis Foundation, and the Duke Clinical Research Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIAMS or the NIH. The authors declare no conflicts of interest.

Keywords

  • JDM
  • calcinosis
  • health disparities
  • juvenile dermatomyositis

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