A Population Based Study of High School Academic Outcomes in Individuals with Childhood-Onset Chronic Rheumatic Diseases in Manitoba, Canada

Siok Hoon Lily Lim^1,2, Ruth Ann Marrie³, Okechukwu Ekuma⁴, Marni Brownell⁴, Christine A. Peschken⁵, Carol A Hitchon⁶, Kerstin Gerhold^7,8 and Lisa Lix⁹, ¹Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada, ²Pediatrics, University of MAnitoba, Winnipeg, MB, Canada, ³Internal Medicine, University of Manitoba, Winnipeg, MB, Canada, ⁴Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada, ⁵RR 149G, University of Manitoba, Winnipeg, MB, Canada, ⁶University of Manitoba, Winnipeg, MB, Canada, ⁷Pediatrics, University of Manitoba, Winnipeg, MB, Canada, ⁸Faculty of Health Sciences, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada, ⁹Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Education, outcomes, Pediatric rheumatology, population studies and prognostic factors

Session Information

Date: Monday, October 22, 2018

Session Title: 4M084 ACR Abstract: Pediatric Rheum–Clinical I: Outcomes & Comorbidities (1846–1851)

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Childhood-onset chronic rheumatic diseases (ChildCRD) are rheumatic diseases with onset <18 years old, including juvenile arthritis (JA) and systemic autoimmune rheumatic diseases (SARD). ChildCRD patients experience poor health during their school years, which could impact educational performance and future employment. Previous studies have not demonstrated poorer educational outcomes in ChildCRD, but were limited to clinic populations and therefore may not produce generalizable results. We have used a population-based approach to compare the grade 12 academic performance of ChildCRD individuals to that of matched controls without ChildCRD.

Methods:

Population: All ChildCRD patients for the province of Manitoba, Canada: JA and SARDs (systemic lupus erythematosus, Sjogren’s syndrome, inflammatory myositis and systemic sclerosis), were ascertained from a clinic registry (1984-2014) maintained by a single pediatric rheumatologist. Registry data were anonymously linked to the administrative health, education and social data housed at the Manitoba Centre for Health Policy (MCHP), including: health insurance registry (to ascertain healthcare coverage and demographics), hospital records, physician billing claims, education, social services and employment records. The ChildCRD cohort included individuals from the 1979- 1998 birth cohorts (i.e., completed grade 12 in 1996- 2015). The control population was derived by matching 5:1, by age, sex and residential postal codes. Outcomes: MCHP has developed a language arts achievement index (LAI) and maths achievement index (MAI), using scores from the grade 12 standards tests and enrollment information. Prognostic factors: Socioeconomic status was defined from an area-based socioeconomic factor index 2 (SEFI2) based on census data. Psychiatric comorbidity was defined using validated diagnostic algorithms. Social factors included maternal age at first childbirth, family ever on income assistance, family ever involved with child welfare services.

Results: A total of 541 Manitoban ChildCRD patients (497 JA, 44 SARD), 70 % females, mean age at diagnosis 9.33 (± 4.91) years, were linked to the administrative data. A total of 2713 matches without ChildCRD (controls) were selected. ChildCRD patients have lower score categories (worse performance) than controls (LAI: -0.220, 95%CI -0.314 – -0.125, p<0.0001; MAI: -0.214, 95% CI -0.310– -0.119, p<0.0001). In multivariable linear regression models adjusted for birth cohort, SEFI2, maternal age at first childbirth, family on income assistance, child in care and disease course psychiatric comorbidity, ChildCRD patients still had lower LAI and MAI test score categories (LAI: -0.232, 95% CI -0.315– -0.149; MAI: -0.228, 95%CI -0.313– -0.142) than controls.

Conclusion: This population-based study of patients with ChildCRD shows that ChildCRD has a detrimental effect on educational results, compared to matched, disease-free individuals. ChildCRD exerts an independent effect on standardized education outcomes independent of socioeconomic, demographic and psychiatric comorbidities.

Disclosure: S. H. L. Lim, None; R. A. Marrie, None; O. Ekuma, None; M. Brownell, None; C. A. Peschken, None; C. A. Hitchon, None; K. Gerhold, None; L. Lix, None.

To cite this abstract in AMA style:

Lim SHL, Marrie RA, Ekuma O, Brownell M, Peschken CA, Hitchon CA, Gerhold K, Lix L. A Population Based Study of High School Academic Outcomes in Individuals with Childhood-Onset Chronic Rheumatic Diseases in Manitoba, Canada [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/a-population-based-study-of-high-school-academic-outcomes-in-individuals-with-childhood-onset-chronic-rheumatic-diseases-in-manitoba-canada/. Accessed April 8, 2020.

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