Cumulative Social Disadvantage Associated with Childhood Arthritis: A<scp>Cross‐Sectional</scp>Analysis of the National Survey of Children's Health

Soulsby, William Daniel; Lawson, Erica; Pantell, Matthew S.

doi:10.1002/acr.24991

Cited by 3 publications

(4 citation statements)

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“…For example, a recent study of children with childhood arthritis showed an association between cumulative social adversity and severity of disease, and is consistent with our data showing positive associations between cumulative social risk and inflammatory markers. 42 Our work also suggests that when biomarker results can inform clinical care, it may be helpful to collect samples from children at highest risk of having results at the extremes, such as those experiencing chronic and cumulative social adversity. Just as policies have been implemented to encourage screening for social adversity through reimbursements or requirements, as biomarkers become more clinically meaningful to informing care, policies incentivizing stress biomarker screening among those most at risk for extreme values could encourage clinical practice change.…”

Section: Discussionmentioning

confidence: 97%

Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children

Pantell,

Silveira,

de Mendonça Filho

et al. 2024

Pediatr Res

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Background Prior work has found relationships between childhood social adversity and biomarkers of stress, but knowledge gaps remain. To help address these gaps, we explored associations between social adversity and biomarkers of inflammation (interleukin-1β [IL-1β], IL-6, IL-8, tumor necrosis factor-alpha [TNF-α], and salivary cytokine hierarchical “clusters” based on the three interleukins), neuroendocrine function (cortisol, cortisone, dehydroepiandrosterone, testosterone, and progesterone), neuromodulation (N-arachidonoylethanolamine, stearoylethanolamine, oleoylethanolamide, and palmitoylethanolamide), and epigenetic aging (Pediatric-Buccal-Epigenetic clock). Methods We collected biomarker samples of children ages 0–17 recruited from an acute care pediatrics clinic and examined their associations with caregiver-endorsed education, income, social risk factors, and cumulative adversity. We calculated regression-adjusted means for each biomarker and compared associations with social factors using Wald tests. We used logistic regression to predict being in the highest cytokine cluster based on social predictors. Results Our final sample included 537 children but varied based on each biomarker. Cumulative social adversity was significantly associated with having higher levels of all inflammatory markers and with cortisol, displaying a U-shaped distribution. There were no significant relationships between cumulative social adversity and cortisone, neuromodulation biomarkers or epigenetic aging. Conclusion Our findings support prior work suggesting that social stress exposures contribute to increased inflammation in children. Impact Our study is one of the largest studies examining associations between childhood social adversity and biomarkers of inflammation, neuroendocrine function, neuromodulation, and epigenetic aging. It is one of the largest studies to link childhood social adversity to biomarkers of inflammation, and the first of which we are aware to link cumulative social adversity to cytokine clusters. It is also one of the largest studies to examine associations between steroids and epigenetic aging among children, and one of the only studies of which we are aware to examine associations between social adversity and endocannabinoids among children. Clinical Trial Registration: NCT02746393

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Section: Discussionmentioning

confidence: 97%

Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children

Pantell,

Silveira,

de Mendonça Filho

et al. 2024

Pediatr Res

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“…Additional studies could assess correlation of accumulated social disadvantage (low guardian education, low household income level, underinsured status, and high adverse childhood experience score) with juvenile LS and SSc severity [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Healthcare disparities have been found to affect many health outcomes including disease severity, long-term outcome, and mortality [10][11][12]. Although access to care and diagnostic delay for several pediatric rheumatic diseases has been studied, there is limited information for juvenile LS and SSc [12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Barriers to care in juvenile localized and systemic scleroderma: an exploratory survey study of caregivers’ perspectives

et al. 2023

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Background Juvenile localized scleroderma (LS) and systemic sclerosis (SSc) are rare pediatric conditions often associated with severe morbidities. Delays in diagnosis are common, increasing the risk for permanent damage and worse outcomes. This study explored caregiver perspectives on barriers they encountered while navigating diagnosis and care for their child’s scleroderma. Methods In this cross-sectional study, caregivers of juvenile LS or SSc patients were recruited from a virtual family scleroderma educational conference and a juvenile scleroderma online interest group. The survey queried respondents about their child’s condition and factors affecting diagnosis and treatment. Results The response rate was 61% (73/120), with 38 parents of LS patients and 31 parents of SSc patients. Most patients were female (80%) and over half were non-Hispanic white (55%). Most families had at least one person with a college education or higher (87%), traveled ≤ 2 h to see their rheumatologist (83%), and had private insurance (75%). Almost half had an annual household income ≥ $100,000 (46%). Families identified the following factors as barriers to care: lack of knowledge about scleroderma in the medical community, finding reliable information about pediatric scleroderma, long wait times/distances for a rheumatology/specialist appointment, balance of school/work and child’s healthcare needs, medication side effects, and identifying effective medications. The barrier most identified as a major problem was the lack of knowledge about juvenile scleroderma in the medical community. Public insurance, household income less than $100,000, and Hispanic ethnicity were associated with specific barriers to care. Lower socioeconomic status was associated with longer travel times to see the rheumatologist/specialist. Diagnosis and systemic treatment initiation occurred at greater than one year from initial presentation for approximately 28% and 36% of patients, respectively. Families of LS patients were commonly given erroneous information about the disease, including on the need and importance of treating active disease with systemic immunosuppressants in patients with deep tissue or rapidly progressive disease. Conclusion Caregivers of children with LS or SSc reported numerous common barriers to the diagnosis, treatment, and ongoing care of juvenile scleroderma. The major problem highlighted was the lack of knowledge of scleroderma within the general medical community. Given that most of the caregiver respondents to the survey had relatively high socioeconomic status, additional studies are needed to reach a broader audience, including caregivers with limited English proficiency, geographical limitations, and financial constraints, to determine if the identified problems are generalizable. Identifying key care barriers will help direct efforts to address needs, reduce disparities in care, and improve patient outcomes.

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“…Patients are often referred to several specialists before seeing a rheumatologist and obtaining a diagnosis. Healthcare disparities have been found to play an important role in access to care and diagnostic delay for several pediatric rheumatic diseases, but this issue has not been examined for juvenile LS and SSc (10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Barriers to Care in Juvenile Localized and Systemic Scleroderma: An Exploratory Survey Study of Caregivers’ Perspectives

Stubbs

Ferry

Guffey

et al. 2023

Preprint

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Background: Juvenile localized scleroderma (LS) and systemic sclerosis (SSc) are rare pediatric conditions often associated with severe morbidities. Delays in diagnosis are common, increasing the risk for permanent damage and worse outcomes. This study explored caregiver perspectives on barriers they encountered while navigating diagnosis and care for their child’s scleroderma. Methods: In this cross-sectional study, caregivers of juvenile LS or SSc patients were recruited from a virtual family scleroderma educational conference and a juvenile scleroderma online interest group. The survey queried respondents about their child’s condition and factors affecting diagnosis and treatment. Results: The response rate was 61% (73/120), with 38 parents of LS patients and 31 parents of SSc patients. Most patients were female (80%) and over half were non-Hispanic white (55%). Most families had at least one person with a college education or higher (87%), traveled < 2 hours to see their doctor (83%), and had private insurance (75%). Almost half had an annual household income > $100,000 (46%). Families identified the following factors as barriers to care: lack of knowledge about scleroderma in the medical community, finding reliable information about pediatric scleroderma, long wait times for a rheumatology/specialist appointment, balance of school/work and child’s healthcare needs, medication side effects, and identifying effective medications. The barrier most identified as a major problem was the lack of knowledge about juvenile scleroderma in the medical community. Diagnosis and systemic treatment initiation occurred at greater than one year from initial presentation for approximately 28% and 36% of patients, respectively. Conclusion: Caregivers of children with LS or SSc reported numerous common barriers to the diagnosis, treatment, and ongoing care of juvenile scleroderma. The major problem highlighted was the lack of knowledge of scleroderma within the general medical community. Given that most of the caregiver respondents to the survey had relatively high socioeconomic status, additional studies are needed to reach a broader audience, including caregivers with limited English proficiency, geographical limitations, and financial constraints, to determine if the identified problems are generalizable. Identifying key care barriers will help direct efforts to address needs, reduce disparities in care, and improve patient outcomes.

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Cumulative Social Disadvantage Associated with Childhood Arthritis: ACross‐SectionalAnalysis of the National Survey of Children's Health

Cited by 3 publications

References 14 publications

Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children

Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children

Barriers to care in juvenile localized and systemic scleroderma: an exploratory survey study of caregivers’ perspectives

Barriers to Care in Juvenile Localized and Systemic Scleroderma: An Exploratory Survey Study of Caregivers’ Perspectives

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