Race, Income, and Disease Outcomes in Juvenile Dermatomyositis

Abstract

Objective To determine the relationship between 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, 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 family income, and significantly worse scores on measures of physical function, disease activity and quality of life measures. Lower income subjects 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 in time to diagnosis or disease duration. Using calcinosis as a marker of disease morbidity, Black race, annual family income less than $50,000 per year, negative ANA, and delay in diagnosis greater than 12 months were associated with calcinosis. Conclusions Minority race and lower income are associated with worse morbidity and outcomes in subjects with JDM. Calcinosis was more common in Black subjects. Future studies are needed to further understand these associations so that efforts may be developed to address health disparities in subjects with JDM and improve disease outcomes.

Assessment of traditional and non-traditional risk factors for premature atherosclerosis in children with juvenile dermatomyositis and pediatric controls

“…The participants in this study primarily represent a population of Black and Hispanic youth from low income households in an inner-city clinic. Previous studies have demonstrated that racial and ethnic disparities are associated with worse morbidity and adult outcomes in children with chronic disease, including JDM [52][53][54]. Although it is difficult to apply adult cutoffs to children, in this study, 63% of our total group demonstrated endothelial dysfunction based on the adult RHI cutoff of 1.67.…”

Clinical phenotypes and biologic treatment use in juvenile dermatomyositis-associated calcinosis

“…There have been many studies attempting to identify risk factors or associations of calcinosis in JDM patients in order to further define the at-risk patient population. Actionable risk factors previously identified include a delay to treatment and/or prolonged disease duration [5, 11, 12] and initial treatment intensity [13, 14]; prognostic factors included race [15–17], male sex [15], underlying cardiac disease [18, 19], presence of joint contractures [18], and presence of certain myositis-specific antibodies [20, 21]; genetic risks were also identified [22, 23]. However, in some large cohorts, no risk factors are identified [24].…”

Inpatient burden of juvenile dermatomyositis among children in the United States

“…time to diagnosis, disease duration, and treatment. [ 34 ] In our own study, we did not find that Black patients experienced a difference in hospitalization, length of stay, or cost of care, although we did find that these outcomes differed among other minority groups. Further research examining the relationship of race/ethnicity to outcomes in JDM are warranted.…”