Differences in African American and Caucasian Children with Uveitis

Abstract

 

Purpose

 

Childhood uveitis can lead to ocular complications and vision loss. Few studies have examined the association of race with uveitis, hence exploration of its' role could improve outcomes.

 

Methods

 

In our prospective cohort of 92 children with uveitis, rheumatology and ophthalmology medical record reviews and parent/patient questionnaires were done every 3-6 months (2011-2014). We collected data on demographics, uveitis, and quality of life (QOL)/function.

 

Results

 

We compared children with JIA associated uveitis (JIAU) and all other forms of uveitis (IU) (Table 1). IU were diagnosed at older age (p = 0.006), more likely had intermediate (p<0.001) and posterior (p=0.006) uveitis, visual acuity (VA) worse than 20/40 or 20/200 (p=0.003) and ocular complications. No differences noted in insurance, surgeries, and treatment. JIAU had worse general QOL measured by PedsQL (p=0.010), but similar vision related QOL/function (EYE-Q).<br /> <br /> More Caucasians (W) had JIAU whereas more African Americans (AA) had IU (p=0.003). We compared children with JIAU and IU by race, and AA were more likely to be older at diagnosis (p=0.014), have Medicaid (p=0.008), intermediate uveitis (p=0.014), bilateral disease (p=0.018), history of VA worse than 20/40 (p=0.002) or 20/200 (p<0.001), and ocular complications (Table 2). Both groups had a similar initial ocular exam and treatment. Additionally, in comparing children with IU only by race, we noted similar ocular disease with no significant differences in clinical features.<br /> <br /> On multivariate analysis, AA race and IU (OR = 3.79; 95% CI [1.11-12.89] and OR = 3.15; 95% CI [1.19-8.32]) were the best combination of predictors for uveitis complications, whereas AA race, IU and age at uveitis diagnosis were the best combination of predictors for severe uveitis (VA worse than 20/200 and/or uveitis complication) (OR = 4.40; 95% CI [1.18 - 16.37], 4.65 (95% CI [1.63-13.28] and 0.91 [0.81 - 1.02 ]).

 

Conclusions

 

Children with IU may have more severe uveitis than those with JIAU. Since more AA children had IU, we compared children with uveitis by race and found that AA had poorer outcomes. There were no significant clinical differences in AA and W with IU. AA children were diagnosed with uveitis at a later age and demonstrated more severe uveitis at referral (poorer vision, increased complications). Potential causes that warrant further study include underlying disease severity, access to medical care and referral bias.