title: The association between low socioeconomic status with high physical limitations and low illness self-perception in patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study.
abstract: OBJECTIVE
  To examine the association between socioeconomic status (SES) and delay to a pediatric rheumatology clinic, disease severity, and illness perception in patients with juvenile idiopathic arthritis in England.
  
  
  METHODS
  Using the Index of Multiple Deprivation, 923 consecutive children from the Childhood Arthritis Prospective Study were assigned to SES groups: high-SES (19.1%), middle-SES (44.5%), or low-SES (36.4%). At baseline, disease activity was assessed, and the Childhood Health Assessment Questionnaire (C-HAQ), the Illness Perception Questionnaire, and the Child Health Questionnaire, version Parent Form 50, were completed. Linear median regression analyses or zero-inflated negative binominal (ZINB) regression analyses were used.
  
  
  RESULTS
  Delay to first pediatric rheumatology consultation was the same between the 3 SES groups. Although disease activity scores assessed by the pediatric rheumatologist did not differ between the 3 SES groups, persons in the low-SES group recorded higher C-HAQ scores compared to the high-SES group (zero-inflated part of ZINB odds ratio 0.28 [95% confidence interval (95% CI) 0.14, 0.55], count part of ZINB β 0.26 [95% CI 0.05, 0.48]). Parents with low SES also reported more often that their children's school work or activities with friends had been limited. Furthermore, the low-SES group had a worse perception about the consequences of the disease and the effect of treatment than those in the high-SES group.
  
  
  CONCLUSIONS
  Patients from a low-SES background report more problems with daily activities and have a lower perception of the consequences of the disease than patients from a high-SES background, warranting special attention from a multidisciplinary team.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Suzanne M M
authors.initials: SM
authors.lastname: Verstappen
authors.forename: Joanna
authors.initials: J
authors.lastname: Cobb
authors.forename: Helen E
authors.initials: HE
authors.lastname: Foster
authors.forename: Bo
authors.initials: B
authors.lastname: Fu
authors.forename: Eileen
authors.initials: E
authors.lastname: Baildam
authors.forename: Lucy R
authors.initials: LR
authors.lastname: Wedderburn
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Davidson
authors.forename: John
authors.initials: J
authors.lastname: Ioannou
authors.forename: Alice
authors.initials: A
authors.lastname: Chieng
authors.forename: Kimme L
authors.initials: KL
authors.lastname: Hyrich
authors.forename: Wendy
authors.initials: W
authors.lastname: Thomson
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000191:economics* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004739:England; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D054624:Health Status Disparities; D006801:Humans; D016014:Linear Models; D008297:Male; D009043:Motor Activity; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation; D012219:Rheumatology / Q000379:methods*; D012649:Self Concept; D012720:Severity of Illness Index; D012923:Social Class; D011795:Surveys and Questionnaires