ArticleArthritis care & research2025
Multicenter Study of Associations Between Area-Level Child Opportunity, Initial Disease Severity, and Outcomes Among Children with Lupus.
Article in Arthritis care & research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Contextual nonmedical health factors and critical care-related outcomes: a systematic review.Critical care (London, England) · 2025Pooled it
- Assessing the Relationship Between Multidimensional Area-Level Indicators and Lupus Disease Activity in Children.Children (Basel, Switzerland) · 2026Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
objectiveChild opportunity encompasses neighborhood resources and conditions that influence healthy childhood development. We determined whether area-level opportunity is associated with disease severity or disease control in a geographically and socioeconomically diverse multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE).
methodsWe linked medical records of patients with cSLE at three tertiary centers (2016-2022) to the Child Opportunity Index (COI) 2.0 (29 indicators across education, health and environment, socioeconomics). Primary outcomes included severe initial disease presentation (composite of Systemic Lupus Erythematosus Disease Activity Index [SLEDAI-2K] ≥10, intensive care, or dialysis) and acute care (inpatient/emergency) visits. Associations between nationally ranked COI levels and outcomes were estimated using mixed effects models clustered by site and adjusted for age, sex, race and ethnicity, language, and insurance status.
resultsAmong 538 patients with cSLE, living in areas with low versus very high COI was associated with 1.93 times higher adjusted odds of severe disease presentation (95% confidence interval [CI] 1.05-3.57) and 2.03 higher adjusted incidence of acute care visits within the first year (95% CI 1.29-3.18). At the most recent follow-up, living in low versus very high COI areas was associated with higher disease activity (adjusted β 1.69 [95% CI 0.54-2.84]) and lower odds of concurrent achievement of SLEDAI-2K ≤ 4 and ≤7.5 mg/day of prednisone, adjusted for initial disease severity and disease duration (adjusted odds ratio 0.44 [95% CI 0.22-0.88]).
conclusionStructural inequities in area-level child opportunity may contribute to disparities in both cSLE severity and disease control. Tailoring interventions for communities with low levels of child opportunity may improve access to pediatric subspecialty care and cSLE outcomes.
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