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Gerhold K, Al-Azazi S, El-Matary W, Katz LY, Lim LSH, Marks SD, Lix LM. Health Care Utilization and Direct Costs Prior to Subspecialty Care in Children with Chronic Pain Compared with Other Chronic Childhood Diseases: A Cohort Study. J Pediatr 2024; 271:114046. [PMID: 38582149 DOI: 10.1016/j.jpeds.2024.114046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES To understand the burden associated with pediatric chronic pain (CP) on the health care system compared with other costly chronic diseases prior to subspecialty care. STUDY DESIGN In this retrospective cohort study, we assessed all-cause health care utilization and direct health care costs associated with pediatric CP (n = 91) compared with juvenile arthritis (n = 135), inflammatory bowel disease (n = 90), type 1 diabetes (n = 475) or type 2 diabetes (n = 289), anxiety (n = 7193), and controls (n = 273) 2 and 5 years prior to patients entering subspecialty care in Manitoba, Canada. Linked data from physician encounters, emergency department visits, hospitalizations, and prescriptions were extracted from administrative databases. Differences in health care utilization and direct health care costs associated with CP vs the other conditions were tested using negative binomial and zero-inflated negative binomial regression models, respectively. RESULTS After adjustment for age at diagnosis, sex, location of residence, and socioeconomic status, CP continued to be associated with the highest number of consulted physicians and subspecialists and the highest number of physician billings compared with all other conditions (P < .01, respectively). CP was significantly associated with higher physician costs than juvenile arthritis, inflammatory bowel disease, type 1 diabetes, type 2 diabetes, or controls (P < .01, respectively); anxiety was associated with the highest physician and prescription costs among all cohorts (P < .01, respectively). CONCLUSION Compared with chronic inflammatory and endocrinologic conditions, pediatric CP and anxiety were associated with substantial burden on the health care system prior to subspecialty care, suggesting a need to assess gaps and resources in the management of CP and mental health conditions in the primary care setting.
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Affiliation(s)
- Kerstin Gerhold
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba, CA; Mississippi Center for Advanced Medicine, Madison, MS.
| | - Saeed Al-Azazi
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Manitoba, CA
| | - Wael El-Matary
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
| | - Laurence Y Katz
- Rady Faculty of Health Sciences, Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
| | - Lily S H Lim
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba, CA
| | - Seth D Marks
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
| | - Lisa M Lix
- Rady Faculty of Health Sciences, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
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Nguyen K, Barsalou J, Basodan D, Batthish M, Benseler SM, Berard RA, Blanchette N, Boire G, Bolaria R, Bruns A, Cabral DA, Cameron B, Campillo S, Cellucci T, Chan M, Chédeville G, Chetaille AL, Chhabra A, Couture J, Dancey P, De Bruycker JJ, Demirkaya E, Dhalla M, Duffy CM, Feldman BM, Feldman DE, Gerschman T, Haddad E, Heale L, Herrington J, Houghton K, Huber AM, Human A, Johnson N, Jurencak R, Lang B, Larché M, Laxer RM, LeBlanc CM, Lee JJY, Levy DM, Lim L, Lim LSH, Luca N, McGrath T, McMillan T, Miettunen PM, Morishita KA, Ng HY, Oen K, Park J, Petty RE, Proulx-Gauthier JP, Ramsey S, Roth J, Rosenberg AM, Rozenblyum E, Rumsey DG, Schmeling H, Schneider R, Scuccimarri R, Shiff NJ, Silverman E, Soon G, Spiegel L, Stringer E, Tam H, Tse SM, Tucker L, Turvey S, Twilt M, Duffy KW, Yeung RSM, Guzman J. A decade of progress in juvenile idiopathic athritis treatments and outcomes in Canada: results from ReACCh-Out and the CAPRI registry. Rheumatology (Oxford) 2023:kead560. [PMID: 37851400 DOI: 10.1093/rheumatology/kead560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To assess changes in juvenile idiopathic arthritis (JIA) treatments and outcomes in Canada, comparing a 2005-2010 and a 2017-2021 inception cohorts. METHODS Patients enrolled within three months of diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) and the Canadian Alliance of Pediatric Rheumatology Investigators Registry (CAPRI) cohorts were included. Cumulative incidences of drug starts and outcome attainment within 70 weeks of diagnosis were compared with Kaplan Meier survival analysis and multivariable Cox regression. RESULTS The 2005-2010 and 2017-2021 cohorts included 1128 and 721 patients, respectively. JIA category distribution and baseline clinical juvenile idiopathic arthritis disease activity (cJADAS10) scores at enrolment were comparable. By 70 weeks, 6% of patients (95% CI 5, 7) in the 2005-2010 and 26% (23, 30) in the 2017-2021 cohort had started a biologic DMARD (bDMARD), and 43% (40, 47) and 60% (56, 64) had started a conventional DMARD (cDMARD), respectively. Outcome attainment was 64% (61, 67) and 83% (80, 86) for Inactive disease (Wallace criteria), 69% (66, 72) and 84% (81, 87) for minimally active disease (cJADAS10 criteria), 57% (54, 61) and 63% (59, 68) for pain control (<1/10), and 52% (47, 56) and 54% (48, 60) for a good health-related quality of life. CONCLUSION Although baseline disease characteristics were comparable in the 2005-2010 and 2017-2021 cohorts, cDMARD and bDMARD use increased with a concurrent increase in minimally active and inactive disease. Improvements in parent and patient reported outcomes were smaller than improvements in disease activity.
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Affiliation(s)
- Kelly Nguyen
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Roxana Bolaria
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David A Cabral
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Mercedes Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Paul Dancey
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | | | | | | | | | | | - Tommy Gerschman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie Haddad
- Université de Montréal, Montréal, Quebec, Canada
| | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | | | - Kristin Houghton
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam M Huber
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Human
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Bianca Lang
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Lillian Lim
- University of Alberta, Edmonton, Alberta, Canada
| | - Lily S H Lim
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nadia Luca
- University of Ottawa, Ottawa, Ontario, Canada
| | - Tara McGrath
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | - Hon Yan Ng
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Ross E Petty
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Dax G Rumsey
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | - Gordon Soon
- Health Sciences North, Sudbury, Ontario, Canada
- North York General Hospital, North York, Toronto, Ontario, Canada
| | | | | | - Herman Tam
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori Tucker
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Turvey
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Jaime Guzman
- University of British Columbia, Vancouver, British Columbia, Canada
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Lim LSH, Ekuma O, Marrie RA, Brownell M, Peschken CA, Hitchon CA, Gerhold K, Lix LM. Do Patterns of Early Disease Severity Predict Grade 12 Academic Achievement in Youths With Childhood-Onset Chronic Rheumatic Diseases? J Rheumatol 2023; 50:1165-1172. [PMID: 36725055 DOI: 10.3899/jrheum.220656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test the association of early disease severity with grade 12 standards test performance in individuals with childhood-onset chronic rheumatic diseases (ChildCRDs), including juvenile arthritis and systemic autoimmune rheumatic diseases. METHODS We used linked provincial administrative data to identify patients with ChildCRDs born between 1979 and 1998 in Manitoba, Canada. Primary outcomes were Language and Arts Achievement Index (LAI) scores and Math Achievement Index (MAI) scores from grade 12 standards test results as well as enrollment data. The secondary outcome was enrollment in grade 12 by 17 years of age. Latent class trajectory analysis identified disease severity groups using physician visits following diagnosis. Multivariable linear regression tested the association of disease severity groups with LAI and MAI scores, and logistic regression tested the association of disease severity with age-appropriate enrollment, after adjusting for sociodemographic factors and psychiatric morbidities. RESULTS The study cohort included 541 patients, 70.1% of whom were female. A 3-class trajectory model provided the best fit; it classified 9.7% of patients as having severe disease, 54.5% as having moderate disease, and 35.8% as having mild disease. After covariate adjustment, severe disease was associated with poorer LAI and MAI scores but not with age-appropriate enrollment. CONCLUSION Among patients with ChildCRDs, those with severe disease performed more poorly on grade 12 standards tests, independent of sociodemographic and psychiatric risk factors. Clinicians should work with educators and policy makers to advocate for supports to improve educational outcomes of patients with ChildCRDs.
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Affiliation(s)
- Lily S H Lim
- L.S.H. Lim, MBBS, PhD, K. Gerhold, Dr med habil, MSc, Department of Pediatrics, Rady Faculty of Health Sciences, University of Manitoba;
| | - Okechukwu Ekuma
- O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba
| | - Ruth A Marrie
- R.A. Marrie, MD, PhD, C. A. Peschken, MD, MSc, C.A. Hitchon, MD, MSc, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Marni Brownell
- O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba
| | - Christine A Peschken
- R.A. Marrie, MD, PhD, C. A. Peschken, MD, MSc, C.A. Hitchon, MD, MSc, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Carol A Hitchon
- R.A. Marrie, MD, PhD, C. A. Peschken, MD, MSc, C.A. Hitchon, MD, MSc, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Kerstin Gerhold
- L.S.H. Lim, MBBS, PhD, K. Gerhold, Dr med habil, MSc, Department of Pediatrics, Rady Faculty of Health Sciences, University of Manitoba
| | - Lisa M Lix
- L.M. Lix, PhD, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Lim LSH, Ekuma O, Marrie RA, Brownell M, Peschken CA, Hitchon CA, Gerhold K, Lix LM. A Population-based Study of Grade 12 Academic Performance in Adolescents With Childhood-onset Chronic Rheumatic Diseases. J Rheumatol 2021; 49:299-306. [PMID: 34725181 DOI: 10.3899/jrheum.201514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aims of this study were (1) to compare grade 12 standardized test results of patients diagnosed with childhood-onset chronic rheumatic diseases (ChildCRD) and unaffected peers; and (2) to identify factors associated with test results of patients with ChildCRD and unaffected peers. METHODS This was a population-based retrospective cohort study. All patients with ChildCRD (juvenile arthritis and systemic autoimmune rheumatic diseases) from the only pediatric rheumatology center in Manitoba for birth cohorts January 1979 to December 1998 were linked to the provincial administrative databases containing records of healthcare use and education outcomes. Patients were matched by age, sex, and postal codes to their peers who did not have ChildCRD. The primary outcomes were the grade 12 Language Arts Achievement Index (LAI) and the Math Achievement Index (MAI) scores. ChildCRD, sociodemographic, and mental health factors were tested for their associations with LAI and MAI scores using multivariable linear regression. RESULTS Five hundred and forty-one patients with ChildCRD were matched to 2713 unaffected peers. Patients with ChildCRD had lower LAI and MAI scores compared to their peers. More patients with ChildCRD failed or did not take the language arts (51% vs 41%, P < 0.001) and math (61% vs 55%, P = 0.02) tests. On multivariable analysis, ChildCRD, lower socioeconomic status, younger maternal age at first childbirth, family income assistance, involvement with child welfare services, and mental health morbidities (between ChildCRD diagnosis and standardized testing), were associated with worse LAI and MAI results. CONCLUSION This population-based study showed that patients with ChildCRD performed less well than their peers on grade 12 standardized testing, independent of sociodemographic and mental health comorbidities.
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Affiliation(s)
- Lily S H Lim
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Okekchukwu Ekuma
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Ruth Ann Marrie
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Marni Brownell
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Christine A Peschken
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Carol A Hitchon
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Kerstin Gerhold
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Lisa Marie Lix
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
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Lim LSH, Pullenayegum E, Lim L, Gladman D, Feldman B, Silverman E. From Childhood to Adulthood: The Trajectory of Damage in Patients With Juvenile-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 69:1627-1635. [DOI: 10.1002/acr.23199] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/17/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Lillian Lim
- SickKids Child Health Evaluative Services; Toronto Ontario Canada
| | - Dafna Gladman
- University of Toronto and Toronto Western Hospital; Toronto Ontario Canada
| | - Brian Feldman
- The Hospital for Sick Children; Toronto Ontario Canada
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