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Insurance Status and Tumor Necrosis Factor Inhibitor Initiation Among Children With Juvenile Idiopathic Arthritis in the CARRA Registry.

Publication ,  Journal Article
Roberts, JE; Williams, K; Dallas, J; Eckert, M; Huie, L; Smitherman, E; Soulsby, WD; Zhao, Y; Son, MBF; CARRA Registry Investigators,
Published in: J Rheumatol
August 2023

OBJECTIVE: Prompt escalation to tumor necrosis factor inhibitors (TNFis) is recommended for children with juvenile idiopathic arthritis (JIA) and ongoing disease activity despite treatment with conventional disease-modifying antirheumatic drugs (cDMARDs). It is unknown whether these recommendations are equitably followed for children with different insurance types. We assessed the association of insurance coverage on the odds and timing of TNFi use. METHODS: We conducted a retrospective study of children with newly diagnosed JIA in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. We compared the odds of starting a TNFi in the first year and time from cDMARD to TNFi initiation between those with public and private insurance. RESULTS: We identified 1086 children with new JIA diagnoses. Publicly insured children had significantly higher active joint counts and parent/patient global assessment scores at the enrollment visit. They were also more likely to have polyarticular arthritis compared to those with private insurance. Odds of any TNFi use in the first year did not differ between publicly and privately insured children. Publicly insured children were escalated from cDMARD to TNFi more quickly than privately insured children. CONCLUSION: Children who were publicly insured had more severe disease and polyarticular involvement at registry enrollment compared to those who were privately insured. Whereas overall TNFi use did not differ between children with different insurance types, publicly insured children were escalated more quickly, consistent with their increased disease severity. Further research is needed to determine why insurance coverage type is associated with disease severity, including how other socioeconomic factors affect presentation to care.

Duke Scholars

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Published In

J Rheumatol

DOI

EISSN

1499-2752

Publication Date

August 2023

Volume

50

Issue

8

Start / End Page

1047 / 1057

Location

Canada

Related Subject Headings

  • Tumor Necrosis Factor Inhibitors
  • Rheumatology
  • Retrospective Studies
  • Registries
  • Insurance Coverage
  • Humans
  • Child
  • Arthritis, Juvenile
  • Arthritis & Rheumatology
  • Antirheumatic Agents
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Roberts, J. E., Williams, K., Dallas, J., Eckert, M., Huie, L., Smitherman, E., … CARRA Registry Investigators, . (2023). Insurance Status and Tumor Necrosis Factor Inhibitor Initiation Among Children With Juvenile Idiopathic Arthritis in the CARRA Registry. J Rheumatol, 50(8), 1047–1057. https://doi.org/10.3899/jrheum.220871
Roberts, Jordan E., Kathryn Williams, Johnathan Dallas, Mary Eckert, Livie Huie, Emily Smitherman, William D. Soulsby, Yongdong Zhao, Mary Beth F. Son, and Mary Beth F. CARRA Registry Investigators. “Insurance Status and Tumor Necrosis Factor Inhibitor Initiation Among Children With Juvenile Idiopathic Arthritis in the CARRA Registry.J Rheumatol 50, no. 8 (August 2023): 1047–57. https://doi.org/10.3899/jrheum.220871.
Roberts JE, Williams K, Dallas J, Eckert M, Huie L, Smitherman E, et al. Insurance Status and Tumor Necrosis Factor Inhibitor Initiation Among Children With Juvenile Idiopathic Arthritis in the CARRA Registry. J Rheumatol. 2023 Aug;50(8):1047–57.
Roberts, Jordan E., et al. “Insurance Status and Tumor Necrosis Factor Inhibitor Initiation Among Children With Juvenile Idiopathic Arthritis in the CARRA Registry.J Rheumatol, vol. 50, no. 8, Aug. 2023, pp. 1047–57. Pubmed, doi:10.3899/jrheum.220871.
Roberts JE, Williams K, Dallas J, Eckert M, Huie L, Smitherman E, Soulsby WD, Zhao Y, Son MBF, CARRA Registry Investigators. Insurance Status and Tumor Necrosis Factor Inhibitor Initiation Among Children With Juvenile Idiopathic Arthritis in the CARRA Registry. J Rheumatol. 2023 Aug;50(8):1047–1057.

Published In

J Rheumatol

DOI

EISSN

1499-2752

Publication Date

August 2023

Volume

50

Issue

8

Start / End Page

1047 / 1057

Location

Canada

Related Subject Headings

  • Tumor Necrosis Factor Inhibitors
  • Rheumatology
  • Retrospective Studies
  • Registries
  • Insurance Coverage
  • Humans
  • Child
  • Arthritis, Juvenile
  • Arthritis & Rheumatology
  • Antirheumatic Agents