Disparate Disease Activity Outcomes Associated with Demographic Variables in Patients with Juvenile Idiopathic Arthritis in the Pediatric Rheumatology Care and Outcomes Improvement Network Registry

Julia Harris¹, Catherine Bingham², Sheetal Vora³, Cagri Yildirim-Toruner⁴, Kerry Ferraro⁵, Erik Friedrichsen⁶, Michelle Batthish⁷, Jon Burnham⁸, Danielle Fair⁹, Suhas Ganguli¹⁰, Mileka Gilbert¹¹, Beth Gottlieb¹², Tzielan Lee¹³, Daniel Lovell¹⁴, Melissa Mannion¹⁵, Edward Oberle¹⁶, Nancy Pan¹⁷, Linda Ray¹⁸, Michael Shishov¹⁹, Mary Toth²⁰ and Esi Morgan²¹, ¹Children's Mercy Kansas City, Overland Park, KS, ²Penn State Children’s Hospital, Hershey, ³Atrium Health Levine Children's Hospital, Charlotte, NC, ⁴Baylor College of Medicine/ Texas Children's Hospital, Houston, TX, ⁵JIA parent and CHOP volunteer, Lower Gwynedd, PA, ⁶Seattle Children's Hospital, Seattle, ⁷McMaster Children's Hospital, Hamilton, ON, Canada, ⁸Children's Hospital of Philadelphia, Philadelphia, PA, ⁹Medical College of Wisconsin/Children's Wisconsin, Wauwatosa, WI, ¹⁰Hackensack University Medical Center, Hackensack, ¹¹Medical University of South Carolina, Charleston, SC, ¹²Cohen Children's Medical Center, Lake Success, NY, ¹³Stanford University School of Medicine, Palo Alto, CA, ¹⁴Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ¹⁵University of Alabama at Birmingham, Birmingham, AL, ¹⁶Nationwide Children's Hospital, Columbus, OH, ¹⁷Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, ¹⁸University of Mississippi Medical Center, Jackson, MS, ¹⁹Phoenix Children's Hospital, Phoenix, AZ, ²⁰Nemours Foundation, Orlando, FL, ²¹Seattle Children's Hospital, Seattle, WA

Meeting: ACR Convergence 2024

Keywords: Disparities, Juvenile idiopathic arthritis, Outcome measures, Pediatric rheumatology, registry

Session Information

Date: Saturday, November 16, 2024

Title: Pediatric Rheumatology – Clinical Poster I

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) is a North American learning health network focused on improving outcomes in patients with juvenile idiopathic arthritis (JIA). PR-COIN has a shared registry that tracks disease activity outcome measures including the 10-joint clinical Juvenile Arthritis Disease Activity Score (cJADAS10), active joint count, and physician global assessment of disease activity (PGA). To assess for health disparities, PR-COIN stratifies quality measures by demographic variables. Our project assessed the mean cJADAS10 score, mean active joint count, and mean PGA value by race, ethnicity, and sex assigned at birth.

Methods: Data are collected at sites and entered manually or through electronic data transfer into the PR-COIN registry. Disease activity quality measures are tracked monthly on both site-specific and network-wide control charts. Race categories examined in this analysis include White, Black or African American, and Asian. Ethnicity is reported as Hispanic or non-Hispanic. Sex assigned at birth is reported as male or female. We analyzed data from January 2019 to May 2024 and calculated average performance on the mean cJADAS10, mean active joint count, and mean PGA during this time frame.

Results: Black or African American patients have consistently higher mean cJADAS10 scores (4.24), active joint counts (1.06), and PGA values (1.01) compared to other race categories (White (2.82, 0.74, 0.63) and Asian patients (2.02, 0.42, 0.53)) (Figures 1-3). Asian patients had consistently lower mean cJADAS10 scores and active joint count values compared to other race categories since mid-2020 as well (Figures 1 & 2). Female patients also have higher disease activity values (3.07, 0.79, 0.69) in all 3 measures compared to males (2.52, 0.6, 0.58) (Figures 1-3). There were no apparent differences in mean cJADAS10 score, active joint count, and PGA by ethnicity (Figures 1-3).

Conclusion: We found Black or African American patients and female patients with consistently worse disease activity outcomes compared to White/Asian and male patients, respectively. We will continue to stratify our quality measures by demographic variables to assess for disparities. This knowledge is essential to drive future improvement efforts to optimize care for all patients with JIA.

Figure 1. Mean cJADAS10 score by A) Race, B) Ethnicity, and C) Sex assigned at birth.

Figure 2. Mean active joint count value by A) Race, B) Ethnicity, and C) Sex assigned at birth.

Figure 3. Mean physician global assessment of disease activity by A) Race, B) Ethnicity, and C) Sex assigned at birth.

Disclosures: J. Harris: None; C. Bingham: None; S. Vora: None; C. Yildirim-Toruner: None; K. Ferraro: None; E. Friedrichsen: None; M. Batthish: Abbvie, 6, Novartis, 2, Viatris, 12, Unrestricted Educational Grant; J. Burnham: None; D. Fair: None; S. Ganguli: None; M. Gilbert: None; B. Gottlieb: None; T. Lee: None; D. Lovell: AstraZeneca, 12, Consultant, money paid to employer, not individual, Bristol-Myers Squibb(BMS), 5, 12, Contract, money paid to employer, not individual, GlaxoSmithKlein(GSK), 12, Consultant, money paid to employer, not individual, Janssen, 12, Contract, money paid to employer, not individual, Novartis, 12, Consultant, money paid to employer, not individual, Pfizer, 12, DSMB, money paid to employer, not individual, 12, Consultant, money paid to employer, not individual, Roche, 12, Contract, money paid to employer, not individual, United Bioscience Corporation, 12, Consultant, money paid to employer, not individual; M. Mannion: NIAMS K23AR081410, 5, Rheumatology Research Foundation, 5; E. Oberle: None; N. Pan: None; L. Ray: None; M. Shishov: AbbVie/Abbott, 2, Novartis, 2; M. Toth: None; E. Morgan: Pfizer, 5.

To cite this abstract in AMA style:

Harris J, Bingham C, Vora S, Yildirim-Toruner C, Ferraro K, Friedrichsen E, Batthish M, Burnham J, Fair D, Ganguli S, Gilbert M, Gottlieb B, Lee T, Lovell D, Mannion M, Oberle E, Pan N, Ray L, Shishov M, Toth M, Morgan E. Disparate Disease Activity Outcomes Associated with Demographic Variables in Patients with Juvenile Idiopathic Arthritis in the Pediatric Rheumatology Care and Outcomes Improvement Network Registry [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/disparate-disease-activity-outcomes-associated-with-demographic-variables-in-patients-with-juvenile-idiopathic-arthritis-in-the-pediatric-rheumatology-care-and-outcomes-improvement-network-registry/. Accessed .

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