Differences in disease outcomes between medicaid and privately insured children: Possible health disparities in juvenile rheumatoid arthritis

Abstract

Objective. To determine the relationship between health insurance status and disease outcome in children with juvenile rheumatoid arthritis (JRA). Methods. JRA patients followed at a tertiary pediatric rheumatology center were assessed for the number of active joints and number of joints with limited range of motion. Disease activity, patient well-being, and pain were measured. Disability was assessed by the Childhood Health Assessment Questionnaire, health-related quality of life by the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale, and the PedsQL Rheumatology Module. Health care resource utilization was estimated based on the number of billing events for health services coded in administrative databases; these databases also provided information on patient health insurance status. Children insured by Medicaid or similar state programs for low-income families were considered to have Medicaid status. Disease outcomes of children with Medicaid status was compared with that of children with private health insurance. Results. Forty (14%) of the 295 children with JRA had Medicaid status. Patients with Medicaid status were more often of nonwhite race (P < 0.04) and more frequently had a polyarticular or systemic disease course (P ‫؍‬ 0.04) compared with other patients (n ‫؍‬ 255). After correction for differences in disease duration, race, JRA onset, and JRA course between groups, children with Medicaid status continued to have significantly higher disability (P < 0.0003), and lower mean PedsQL Generic Core Scale scores (P < 0.05), while health resource utilization appeared similar between groups. Conclusion. Despite apparently similar health resource utilization and joint involvement, Medicaid status is associated with significantly lower health-related quality of life and higher disability in JRA.

The Association Between Low Socioeconomic Status With High Physical Limitations and Low Illness Self‐Perception in Patients With Juvenile Idiopathic Arthritis: Results From the Childhood Arthritis Prospective Study

“…Parents from a low‐SES background also reported that their child with JIA had been limited in their schoolwork or activities with friends due to emotional difficulties, had problems with their behavior and limited family activities, or had caused tension in the family. Part of these findings is similar to those found in previous studies defining SES at an individual level, such as insurance information 17, education level of parents 18, 19, 28, living in a Canadian reserve 29, and distance to health care centers 19. In this study we used area deprivation level data, which conceptually might be slightly different.…”

Quality of Life and Health Outcomes in Overweight and Non-Overweight Children With Asthma

“…Only a limited number of QOL studies have been conducted with children, with much of the research focusing on the areas of pediatric oncology (Eiser, Eiser, & Stride, 2005;Odame et al, 2006;Russell, Hudson, Long, & Phipps, 2006) and debilitating chronic illnesses, such as rheumatoid arthritis (Brunner et al, 2006;Riddle et al, 2006;Sawyer et al, 2005) and cystic fibrosis (Janse, Sinnema, Uiterwaal, Kimpen, & Gemke, 2004;Koscik et al, 2005;Thomas, Mitchell, O'Rourke, & Wainwright, 2006).…”

Access to Pediatric Rheumatology Care — A Major Challenge to Improving Outcome in Juvenile Idiopathic Arthritis: Table 1.

“…The paucity of appropriately trained pediatric rheumatologists and multidisciplinary teams 24 is likely to contribute to inequity in delivery of appropriate care, and increased recruitment to the specialty is needed. Access to appropriate care may be limited by healthcare costs such as in the USA, where children with JIA covered by basic healthcare insurance are less likely to have eye screening 25 . Biological agents are not available in many parts of the world, and may be subject to "rationing" based on cost-effectiveness (www.nice.org.uk), and availability may be geographically dependent on local health budgets.…”