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

• 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
• ISSN: 0004-3591; 0893-7524; 1529-0131; 1529-0123
• DOI: 10.1002/art.21991

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.