Risk for blindness higher among boys with juvenile idiopathic arthritis-associated uveitis
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Key takeaways:
- Increased risk for blindness was associated with male sex, Black race and Medicaid insurance among patients with JIA-associated uveitis.
- Clinicians should be aware of these disparities when evaluating patients.
Male sex, Black race and insurance coverage with Medicaid were among factors associated with increased risk for developing 20/200 or worse vision among children with juvenile idiopathic arthritis-associated uveitis, according to research.
“Juvenile idiopathic arthritis (JIA), formerly referred to as juvenile rheumatoid arthritis, is the most common rheumatic disease in childhood and the most common systemic disease associated with pediatric uveitis,” Oliver Davidson, from the department of ophthalmology at the University of Washington, and colleagues wrote in Clinical Ophthalmology. “JIA-associated uveitis is minimally symptomatic but associated with a high rate of sight-threatening complications.”
They continued, “Vision loss related to uveitis and its complications can result in lifelong visual impairment for a child, but may be prevented or reduced with early diagnosis and proper treatment.”
In a respective cohort study, Davidson and colleagues used data from the IRIS registry to test the hypothesis that sociodemographic factors and insurance coverage are linked to visual outcomes and complications among individuals with JIA-associated uveitis.
From more than 65 million patient records, researchers identified 1,346 children (median age at diagnosis, 11 years; 72.7% girls; 71.92% white; 5.5% Black) who were diagnosed with JIA-associated uveitis, most of whom had commercial insurance coverage (53.4%) or Medicaid (25.2%).
The primary outcome was incidence of blindness in at least one eye in association with sociodemographic factors, with secondary outcomes including cataract and glaucoma surgery after uveitis diagnosis.
According to results, average visual acuity among 1,001 children with baseline data was 0.22 logMAR in patients’ worst eye and 0.07 logMAR in their best eye. Forty-six patients (3.4%) had cataract surgery, and 28 (2.1%) had glaucoma surgery.
After adjusting for race and insurance, researchers reported that risk for blindness was higher among boys (HR = 2.15), and when adjusting for sex and insurance, the risk for 20/200 or worse vision was 2.5-fold higher among Black or African American patients (HR = 2.54). Among patients with Medicaid insurance, the risk for blindness was more than double, after adjusting for sex and race (HR = 2.23).
Researchers reported no significant risks for cataract or glaucoma surgery in association with the same predictors.
“Despite overall improvements in visual outcomes due to advances in available therapies for JIA-associated uveitis, clinicians should be aware of these disparities and potential barriers to care when evaluating patients with JIA and JIA-associated uveitis,” Davidson and colleagues wrote. “Future efforts may serve to better understand the mechanisms behind the differences we observed by measuring the impact of other social determinants of health.”
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