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

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...

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Published in:	Arthritis and rheumatism Vol. 55; no. 3; pp. 378 - 384
Main Authors:	Brunner, Hermine I., Taylor, Janalee, Britto, Maria T., Corcoran, Melinda S., Kramer, Sandy L., Melson, Paula G., Kotagal, Uma R., Graham, T. Brent, Passo, Murray H.
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 15-06-2006 Lippincott Williams and Wilkins
Subjects:	Adolescent Arthritis, Juvenile - diagnosis Arthritis, Juvenile - physiopathology Arthritis, Juvenile - therapy Biological and medical sciences Child Childhood Health Assessment Questionnaire Disability Evaluation Diseases of the osteoarticular system Disparity Health Services Accessibility - statistics & numerical data Health Status Health‐related quality of life Humans Inflammatory joint diseases Insurance, Health - statistics & numerical data Juvenile idiopathic arthritis Juvenile rheumatoid arthritis Medicaid Medicaid - statistics & numerical data Medical sciences Medically Uninsured - statistics & numerical data Pediatric Quality of Life Inventory Private Sector Prognosis Quality of Life Severity of Illness Index Socioeconomic status Surveys and Questionnaires Human Pediatric Quality of Life Inventory Pediatrics Health-related quality of life Prognosis Socioeconomic status Childhood Health Assessment Questionnaire Diseases of the osteoarticular system Rheumatology Juvenile rheumatoid arthritis Inflammatory joint disease Epidemiology Quality of life Juvenile idiopathic arthritis Chronic Disparity Medicaid Child Health Assessment Questionnaire Stanford
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Summary:	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.
Bibliography:	Dr. Brunner and Ms Taylor contributed equally to this work. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0004-3591 0893-7524 1529-0131 1529-0123
DOI:	10.1002/art.21991