2026/03/09 by Anna Costello, Rui Xiao, Xuemei Zhang +3 · 1 voice
Medicine · Health Professions · #Autoimmune and Inflammatory Disorders Research #Adolescent and Pediatric Healthcare #Rheumatoid Arthritis Research and Therapies
paper · doi:10.1002/acr.80037
openalex publication_date 2026/03/09 · openalex created_date 2026/03/10 · openalex updated_date 2026/08/01
OBJECTIVE: Although early diagnosis improves long-term outcomes, patients with juvenile idiopathic arthritis (JIA) often experience prolonged, circuitous paths to diagnosis. To inform diagnostic improvement, we sought to characterize health care utilization in the year preceding diagnosis. METHODS: We identified 10,021 patients with an incident diagnosis of JIA and 20,042 age- and sex-matched healthy controls in the Merative MarketScan administrative datasets (2014-2022). Using negative binomial or hurdle models, we calculated incidence rate ratios (IRRs) comparing outpatient, inpatient, and emergency department or urgent care (ED/UC) utilization between patients with JIA and controls. RESULTS: In the year before diagnosis, patients with JIA had significantly increased health care utilization compared to controls (IRR 2.55 [95% confidence interval (CI) 2.49-2.62], P < 0.001). Accounting for sex, age, and insurance, utilization was increased across care settings: outpatient (IRR 2.56 [95% CI 2.49-2.62], P < 0.001), inpatient (IRR 2.00 [95% CI 1.48-2.71], P < 0.001), and ED/UC encounters (IRR 1.76 [95% CI 1.67-1.86], P < 0.001). The most common visits by patients with JIA preceding diagnosis were to a general practitioner (91.8%), ED/UC (47.0%), and orthopedist (22.9%). Health care utilization increased as the index date approached. In patients insured by Medicaid, ED/UC care was more frequent (odds ratio 2.05 [95% CI 1.89-2.23]) and orthopedic care less frequent (odds ratio 0.27 [95% CI 0.24-0.34]) than in patients with commercial insurance. CONCLUSION: In the year before diagnosis, children with JIA have significantly higher health care utilization compared to healthy peers. There are differences in the patterns of utilization in patients with Medicaid versus commercial insurance. There may be opportunities for earlier identification of JIA in primary care, orthopedics, and ED/UC.