Proceedings of the 2018 Childhood Arthritis and Rheumatology Research Alliance (CARRA) Scientific Meeting
Bibliographic record
Abstract
BackgroundAdverse Childhood Experiences (ACEs) such as witnessing violence in the home or neighborhood, parental incarceration, and racial or ethnic discrimination are associated with increased risk of chronic disease and poorer health in children and adults.Emerging data suggest an association between exposure to ACEs and autoimmune diseases in adults, but the relationship between ACEs and childhood-onset rheumatologic diseases has not been examined.Our objective was to investigate the relationship between ACEs and arthritis, the most common manifestation of childhood-onset rheumatologic disease. MethodsWe used data from the 2016 National Survey of Children's Health (NSCH) to describe the distribution of ACEs among children with current arthritis compared to 1) children with other chronic acquired physical conditions (CAPC)* and 2) all other children.The NSCH is a survey of sampled households with children <18 years conducted by the National Center for Health Statistics at the Centers for Disease Control.Children were determined to have current conditions, including arthritis, if their guardian indicated yes to both "has a doctor or other health care provider ever told you that this child has…" and "does this child currently have the condition?"We performed bivariate and multivariable logistic regression to determine associations between arthritis and cumulative ACE scores, measured as a categorical variable (0 ACEs, 1 ACE, 2-3 ACEs, >=4 ACEs).Logistic regression was also utilized to determine the relationship between cumulative ACE exposure and comorbid depression/ anxiety.Results Among 50,212 children included in the survey, 16,892 had CAPC and 138 had current arthritis.More children with arthritis had any ACE exposure compared to both children with other CAPC (63.4% vs 46.9%, p<0.001) and all other children (40.1%, p<0.001).The prevalence of all individual ACE categories except racial/ethnic discrimination was significantly higher among children with arthritis compared to other CAPC and all other children.A graded relationship was observed between ACE scores and arthritis in logistic regression models for 1) children with CAPC and 2) all children.An overall significant association between ACE score and arthritis persisted after adjusting for confounders in both models (Table 1).No significant interaction was found between ACE and minority status or between ACE and poverty.Among youth with current arthritis, a graded relationship was observed between ACE scores and odds of comorbid depression/anxiety (Table 2).Conclusions A markedly high prevalence of ACEs is reported among youth with arthritis from a large national survey.Higher ACE scores were associated with increased odds of arthritis.Future investigations should examine how adversity may play a role in arthritis development, disease severity, and physical and mental health outcomes.Protective psychosocial factors, such as resilience, may mitigate the impact of ACEs and should be studied further to inform development of effective interventions.*Allergies, asthma, diabetes, and epilepsy.Ethics Approval Approval for exemption was obtained from the Einstein-Montefiore Institutional Review Board.* CAPC = Chronic acquired physical conditions: allergies, asthma, arthritis, diabetes, and epilepsy.** Children with a history of arthritis, but no current arthritis, were censored from this analysis.^Adjusted for age, sex, minority race
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".