Background/Purpose:
Children with rheumatic diseases often face social determinants of health (SDoH) that affect access and outcomes, yet data in pediatric rheumatology remain limited. We aimed to characterize caregiver-reported SDoH in juvenile idiopathic arthritis (JIA), systemic lupus erythematosus (SLE), and juvenile dermatomyositis (JDM), and to assess disparities by diagnosis, language, race, ethnicity, insurance, and neighborhood deprivation. 

Methods: We conducted a cross-sectional study of caregiver-reported SDoH collected at routine pediatric rheumatology clinic visits from February to May 2023. Of 862 surveys, 562 surveys from unique caregivers met inclusion criteria; duplicates and surveys from ineligible diagnoses were excluded, leaving 417 surveys eligible. Surveys assessed caregiver education, health literacy, food security, housing stability, transportation, and social work support. Neighborhood deprivation was measured using the Area Deprivation Index (ADI). Associations between SDoH and sociodemographic and economic factors were examined using univariate and post-hoc tests with complete case analysis. 

Results: The cohort (mean age 12.1 years; 73.1% JIA, 15.1% SLE; 11.8% JDM (Table 1) revealed that 39% of caregivers reported ≥1 unmet social need, yet only 9% requested social work support. SLE and JDM caregivers reported higher rates of food insecurity and health literacy challenges compared to those with JIA (Table 2). Spanish-speaking, Hispanic/Latino, and publicly- or uninsured families reported disproportionately more unmet needs. Higher ADI was associated with lower caregiver education, difficulty reading hospital materials, housing instability, transportation barriers, and food insecurity (Table 3).

Conclusion:
Children with rheumatic diseases face substantial inequities linked to SDoH, particularly those with SLE or JDM, Hispanic/Latino ethnicity, Spanish-speaking caregivers, or public or no insurance. Incorporating ADI-informed SDoH screening into pediatric rheumatology may help identify high-risk families and guide targeted, equity-focused interventions to improve access and outcomes. 

Demographic Characteristics of Pediatric Rheumatology Patients with Responses to Social Determinants of Health Questionnaire

Analysis of Caregiver Responses to Social Determinants of Health Questionnaire

SDoH Screening in Relationship to ADI

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/unmet-social-needs-in-pediatric-rheumatic-disease-a-study-of-disparities/