ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 0109

The Impact of Marginalization on Health Outcomes in Childhood-onset Systemic Lupus Erythematosus

Ibrahim Mohamed1, Hardil Bhatt2, Paris Moaf3, Lawrence Ng3, Dragana Ostojic-Aitkens3, Bryan Maguire3, Deborah Levy4, Linda Hiraki5, Alene Toulany6, Chelsea DeCoste7 and Andrea Knight8, 1The Hospital for Sick Children, Neurosciences and Mental Health, Research Institute, ON, Canada 3Institute of Biomedical Engineering, University of Toronto, Brampton, ON, Canada, 2Temerty Faculty of Medicine, Toronto, ON, Canada, 3The Hospital for Sick Children, Toronto, ON, Canada, 4Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Services, SickKids Research Institute; Department of Paediatrics, University of Toronto, Toronto, ON, Canada, 5The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada, 6The Hospital for Sick Children, Division of Adolescent Medicine, Department of Paediatrics, University of Toronto,, Toronto, ON, Canada, 7IWK Health Centre, Halifax, NS, Canada, 8The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada

Meeting: ACR Convergence 2022

Keywords: Cohort Study, mental health, Pediatric rheumatology, socioeconomic factors, Systemic lupus erythematosus (SLE)

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Saturday, November 12, 2022

Title: Healthcare Disparities in Rheumatology Poster

Session Type: Poster Session A

Session Time: 1:00PM-3:00PM

Background/Purpose: Adolescents with childhood-onset systemic lupus erythematosus (cSLE) face challenges in managing their disease and mental health. There is increasing evidence that community-level social and economic factors contribute to disparities in health outcomes for marginalized groups, beyond individual-level indicators like income or education. Yet there is limited information on the effects of these community-level factors in cSLE. We sought to investigate the relationship between neighbourhood area-level marginalization and health outcomes in children and adolescents with cSLE.

Methods: We conducted a retrospective cohort study of patients 9-18 years old with cSLE meeting System Lupus International Collaborating Clinics (SLICC) or American College of Rheumatology (ACR) SLE classification criteria and followed in the Lupus Clinic at SickKids between July 2018 and July 2020. The postal codes of patients were linked to the Ontario Marginalization (ON-Marg) Index, a measure derived from the Canadian census to capture health disparities at the area-level. The primary exposures were the four dimensions of the ON-Marg Index: ethnic concentration (concentration of new immigrants and visible minority persons); material deprivation (measure of income, education, single-parent households); residential instability (rates of housing and family instability); and dependency (reflects the population workforce eligibility). Health outcomes included the presence of: i) active disease (adjusted mean SLEDAI score >4) during the study period, ii) disease damage (SLICC/ACR Damage Index score >0) at the latest study visit, and iii) a comorbid psychiatric diagnosis (mood and/or anxiety disorder). We performed univariate and multivariable logistic regression analyses to determine if area-level marginalization was associated with the outcomes, adjusting for age, sex, disease duration, major organ involvement (nephritis and/or central nervous system disease), and glucocorticoid use. Estimates with a p< 0.05 were considered statistically significant.

Results: A total of 184 pediatric patients were included in the study; 29% had active disease, 16% had disease damage, and 18% had a comorbid mood and/or anxiety diagnosis (Table 1). Notably, 61% of patients lived in areas with the highest quintile for ethnic concentration and 46% of patients lived in areas with the lowest quintile for dependency (Figure 1). Those living in areas with higher ethnic concentrations had lower odds of a comorbid psychiatric diagnosis in unadjusted analysis (OR 0.67, 95% CI 0.48-0.94, p=0.021). In adjusted analysis, there were associations between ethnic concentration and lower comorbid psychiatric diagnosis (OR 0.66, 95% CI 0.42-1.04, p=0.073), and dependency with lower active disease (OR 0.56, 95% 0.30-1.04, p=0.066), though not statistically significant (Table 2).

Conclusion: In this sample of patients with cSLE, we found associations between the factors of community-level ethnic concentration and dependency with disease and mental health outcomes. Future studies should explore the patient, provider, and system-level factors influencing medical and psychiatric care among marginalized groups.

Supporting image 1

Table 1. Demographics and Disease Characteristics in Children and Adolescent Patients with cSLE.

Supporting image 2

Figure 1. Quintile distribution of the Ontario Marginalization Index dimensions in the cSLE cohort (n=184). 

Supporting image 3

Table 2. Results of the adjusted logistic regression analyses for marginalization on the medical and psychiatric outcomes of interest.


Disclosures: I. Mohamed, None; H. Bhatt, None; P. Moaf, None; L. Ng, None; D. Ostojic-Aitkens, None; B. Maguire, None; D. Levy, None; L. Hiraki, None; A. Toulany, None; C. DeCoste, None; A. Knight, None.

To cite this abstract in AMA style:

Mohamed I, Bhatt H, Moaf P, Ng L, Ostojic-Aitkens D, Maguire B, Levy D, Hiraki L, Toulany A, DeCoste C, Knight A. The Impact of Marginalization on Health Outcomes in Childhood-onset Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/the-impact-of-marginalization-on-health-outcomes-in-childhood-onset-systemic-lupus-erythematosus/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to ACR Convergence 2022

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-marginalization-on-health-outcomes-in-childhood-onset-systemic-lupus-erythematosus/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology