title: Predictors of access to care in juvenile systemic lupus erythematosus: evidence from the UK JSLE Cohort Study.
abstract: OBJECTIVE
  The objective of this study was to investigate factors that may influence the interval between symptom onset and JSLE diagnosis.
  
  
  METHODS
  Data from all patients recruited to the UK JSLE Cohort Study between 2006 and 2011 and meeting ACR criteria for lupus were analysed. Variables associated with time between symptom onset and diagnosis were identified using correlation tests. Linear regression was used to identify independent predictors of access to care.
  
  
  RESULTS
  Two hundred and fifty-seven children with JSLE were included in the analysis (216 females, 41 males, ratio 5.3:1). The median time from symptom onset to diagnosis was 0.4 years (range 0.0-14.1 years, interquartile range 0.2-1.4). A linear regression model identified being of African or Caribbean origin (P = 0.006), Asian (P = 0.045), referred by a paediatrician (P = 0.047) or having nephritis (P = 0.045) at presentation as independent predictors of shorter time to diagnosis. Being of Caribbean or Asian origin, compared with white, was associated with a 56% and 37% reduction in geometric mean time to diagnosis, respectively. Similarly, being referred to paediatric rheumatology by a paediatrician or having nephritis at presentation was also associated with a 32% and 36% reduction in geometric mean time to diagnosis, respectively.
  
  
  CONCLUSIONS
  Within this national UK cohort, ethnic origin, initial source of referral and having lupus nephritis at presentation were strong predictors of the interval to establishing a diagnosis of JSLE.
authors: Department of Paediatric Rheumatology, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK. evemdsmith@yahoo.co.uk.
authors: Eve M D
authors: EM
authors: Smith
authors: Helen E
authors: HE
authors: Foster
authors: William K
authors: WK
authors: Gray
authors: David
authors: D
authors: Taylor-Robinson
authors: Michael W
authors: MW
authors: Beresford
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D008181:Lupus Nephritis / Q000453:epidemiology*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D044469:Racial Groups; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: JSLE; access to care; cohort; diagnosis; juvenile systemic lupus erythematosus