Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Beverley J. Sheares

Abstract

Background: Prior studies in adults have demonstrated that social drivers of health contribute to disparities in disease burden, management, and healthcare access among individuals with autoimmune disease (AD). There is emerging pediatric evidence suggesting similar patterns, but national-level data describing how social and structural factors shape healthcare access for children with AD remain limited. The aim of this study is to identify the sociodemographic and structural factors associated with healthcare access among children and adolescents with AD in the United States. Understanding these factors can support meaningful advances that will optimize patient-centered care and wraparound services for pediatric AD.Study Design: We conducted a cross-sectional analysis of 1231 children and adolescents aged 0-17 years old with a caregiver-reported diagnosis of AD using merged 2022-23 National Survey on Children’s Health (NSCH) data. Multivariable logistic regression models examined the associations between sociodemographic variables and multiple healthcare access outcomes. Survey weights were applied prior to regression modeling to generate population-level estimates of non-institutionalized children across the United States; however, these results are not nationally representative. Results: Food insecurity is significantly and consistently associated with decreased odds of accessing medical care across multiple domains. Additional factors significantly associated with healthcare access among children with AD in the United States included race/ethnicity, caregiver educational attainment, household income level, primary household language, and exposure to community-based adverse childhood experiences. Conclusions: In this national cross-sectional study, several markers of social disadvantage were significantly associated with odds of accessing health care among children with AD in the United States. These findings align with existing adult studies and limited pediatric studies and underscore the central role of structural and social factors, particularly food insecurity, in shaping access to care. Interventions aimed at improving pediatric AD outcomes should incorporate patient-centered wraparound services that address the social contexts in which children with AD receive care.

Comments

This is an Open Access Thesis.

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