Differences in quality of life in patients with cutaneous lupus erythematosus with varying income levels

Joseph, Adrienne; Prasad, Smriti; Hynan, Linda S.; Chren, Mary Margaret; Chong, Benjamin F.

doi:10.1177/0961203321999724

Cited by 6 publications

(14 citation statements)

References 27 publications

(33 reference statements)

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“…Finally, socioeconomic factors like reduced income and low educational attainment have been associated with worse outcomes in patients with CLE ( 7 , 15 , 19 , 23 , 26 , 30 , 33 , 35 ). A diagnosis of CLE comes with significant financial burden.…”

Section: Discussionmentioning

confidence: 99%

“…A diagnosis of CLE comes with significant financial burden. Inadequate funds or insurance coverage may lead to some patients not being able to afford their treatments, contributing to increased CLE damage and poorer overall outcomes ( 35 ). Those with lower socioeconomic status may be more susceptible to social isolation or increased sense of discrimination, contributing to poorer quality of life ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…Annual income < $10,000 corresponded to poorer SKINDEX-29+3 symptoms ( p = 0.002) and lupus-specific ( p = 0.02) sub-domain scores ( 7 ). Joseph et al also found significant differences in SKINDEX 29+3 lupus-specific ( p < 0.05), functions, symptoms ( p < 0.01), and emotions subdomains ( p < 0.001) between the < $10,000 and >$50,000 annual income categories ( 35 ). Within this cohort, Whites comprised the largest proportion in the highest income bracket (58.5%), whereas Blacks comprised a majority of the lowest income bracket (67.1%) ( p < 0.001).…”

Section: Income Education and Geographic Locationmentioning

confidence: 96%

“…Higher levels of poverty were associated with a significantly increased likelihood of rehospitalization within 1 year ( p < 0.0047) and being female ( p < 0.002) ( 19 ). Income level was also shown to have an inverse relationship with CLASI damage scores ( p = 0.006), but no significant relationship to CLASI activity scores ( 35 ).…”

Section: Income Education and Geographic Locationmentioning

confidence: 98%

“…Socio-demographic factors including income, education level, and geographic location can affect patients with CLE ( 7 , 19 , 28 , 30 , 33 , 35 ). CLE patients have been shown to experience significantly high healthcare expenditures, particularly if depression is present.…”

Section: Income Education and Geographic Locationmentioning

confidence: 99%

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Influence of Socio-Demographic Factors in Patients With Cutaneous Lupus Erythematosus

Walker

Clifton

et al. 2022

Front. Med.

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Cutaneous lupus erythematosus (CLE) is a chronic autoimmune skin disease with potential for systemic involvement, disfigurement, and significant disease burden. The relationships of demographics and socioeconomic status with patients with CLE are emerging topics with important clinical implications. The primary objective of our study is to perform a literature review of studies that have investigated demographic and socioeconomic factors amongst patients with CLE and determine whether these factors influence diagnosis frequency, disease severity and outcomes or health related quality of life. We searched multiple databases to identify literature addressing CLE and concepts such as race, ethnicity, gender, income, education level and geographic location. Information regarding primary research objective was extracted from all full text articles, and a summary of findings was prepared. We found that race and ethnicity can influence CLE diagnosis frequency and disease outcomes. Chronic cutaneous lupus (CCLE) occurs more frequently in Black patients, often with higher overall disease damage. Differences between genders exist in CLE in terms of health-related quality of life, as female gender was a risk factor for worse quality of life in several studies. Lower income, low educational attainment, and lack of health insurance all contribute to poorer overall outcomes in CLE patients. This review will help inform physicians about populations at risk for potentially worse outcomes to guide treatment decisions for patients with CLE and provide important information to design interventions that address modifiable social determinants of health in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Income Education and Geographic Locationmentioning

confidence: 96%

Section: Income Education and Geographic Locationmentioning

confidence: 98%

Section: Income Education and Geographic Locationmentioning

confidence: 99%

See 3 more Smart Citations

Influence of Socio-Demographic Factors in Patients With Cutaneous Lupus Erythematosus

Walker

Clifton

et al. 2022

Front. Med.

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Skin-Related Quality of Life During Autoimmune Bullous Disease Course

Hopkins,

Jimenez,

Taliercio

et al. 2023

JAMA Dermatol

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ImportanceAutoimmune bullous diseases (AIBDs) are chronic relapsing-remitting conditions with significant morbidity. Skin-related quality of life (SRQL) may vary by AIBD subtype and disease type. Disease severity and flare severity can be difficult to define; SRQL can offer a key insight.ObjectivesTo investigate the Skindex-16 score as an SRQL measure in AIBD subtypes during flare and nonflare states and to evaluate Skindex-16 construct validity.Design, Setting, and ParticipantsThis retrospective cross-sectional study was conducted from September 1, 2016, to February 1, 2020, among 192 patients at the University of Utah Health autoimmune dermatology clinic with pemphigoid, pemphigus, dermatitis herpetiformis, and linear immunoglobulin A disease. Patients had an encounter-associated diagnosis, Skindex-16 scores, and self-reported flare status. Statistical analysis was performed from March 2022 to June 2023.ExposureAutoimmune bullous disease subtype and patient-reported flare status.Main Outcomes and MeasuresSkindex-16 domain scores (emotions, symptoms, and functioning; range, 0-100, where 0 indicates no effect on SRQL and 100 maximum effect) and individual item scores were described by disease and flare status. Flare scores were expected to be higher by at least the standard error of measurement (SEm). Convergent validity was assessed using Spearman correlation among Skindex-16 scores, serologic titers, and other patient-reported outcome measures. Floor or ceiling domain scores (&lt;20% of sample scoring either lowest or highest possible domain scores, respectively) were assessed for Skindex-16. Structural validity was assessed using confirmatory factor analysis (CFA).ResultsThe study included 192 patients with 212 visits (median age, 68 years [IQR, 58-76 years]; 123 of 212 women [58.0%]) with Skindex-16 scores (64 in flare state and 148 in nonflare state). Median Skindex-16 domain scores were higher for all disease categories among patients in the flare state compared with those in the nonflare state (pemphigoid [emotions: flare, 52.4 (IQR, 38.1-69.0); nonflare, 7 (IQR, 0-17); symptoms: flare, 37.5 (IQR, 29.2-58.0); nonflare, 13 (IQR, 0-25); functioning: flare, 26.7 (IQR, 10.0-56.7); nonflare, 0 (IQR, 0-3)]; pemphigus [emotions: flare, 54.8 (IQR, 31.0-81.0; nonflare, 0 (IQR, 0-19); symptoms: flare, 58.3 (IQR, 41.7-70.8); nonflare, 4 (IQR, 0-12.5); functioning: flare, 26.7 (IQR, 13.3-83.3); nonflare, 0 (IQR, 0-3.33)]; dermatitis herpetiformis [emotions: flare, 72.6 (IQR, 34.7-90.5); nonflare, 14.3 (IQR, 2.4-26.2); symptoms: flare, 69 (IQR, 31.3-85.4); nonflare, 12.5 (IQR, 0-29.2); functioning: flare, 38.3 (IQR, 5.0-63.2); nonflare, 0 (IQR, 0-13.3)]. This difference exceeded SEm cut points. Cronbach α was greater than 0.80 for all domains and AIBDs. Moderate or low correlations were seen with desmoglein 1 and bullous pemphigoid 180 titers. Moderate correlation existed between Skindex-16 and Patient-Reported Outcomes Measurement Information System Depression scores (emotions: ρ = 0.40; symptoms: ρ = 0.41; functioning: ρ = 0.48), and strong correlation existed between Skindex-16 and patient-reported disease severity (emotions: ρ = 0.71; symptoms: ρ = 0.73; functioning: ρ = 0.66). Floor domain scores greater than 20% were seen among patients in the nonflare state, but ceiling domain scores were rare (&lt;10% for all domains); CFA model fit was poor.Conclusions and RelevanceIn this cross-sectional study, SRQL was highly associated with flare of AIBDs. Skin-related quality of life was worse during periods without flare among patients with pemphigoid and dermatitis herpetiformis compared with pemphigus, highlighting residual SRQL morbidity. Skindex-16 showed good construct validity, but the poor CFA model fit needs further research. Clinical measurement of SRQL in AIBDs can add critical disease-severity information.

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Evaluation of Skindex-16 construct validity in routinely collected psoriasis data: a retrospective analysis of the relationship between overall physician global assessment scores and Skindex-16 and measure discordance

et al. 2022

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Patient-reported outcome measures (PROMs) capture disease severity metrics from the patient's perspective, including healthrelated quality of life (HRQL). Disease-speci c validation of PROMs improves their clinical utility. We evaluated construct validity (HRQL) for Skindex-16 in routinely seen psoriasis patients and characterized instances of discordance between Skindex-16 scores and clinician reported outcome measure of disease severity. We retrospectively studied psoriasis patients seen by University of Utah Dermatology from 2016 to 2020. Cross-sectional construct validity was assessed using quantile regression and Spearman correlation between overall physician global assessment (OPGA) score and Skindex-16 scores.Longitudinal, within-subject correlation was performed using linear mixed models. Discordance (10th percentile or lower OPGA and 90th percentile or higher poor HRQL; cspHRQL] or the reverse [severe skin, good HRQL; ssgHRQL]) was characterized descriptively. 681 rst-visit patients with psoriasis were included. Median overall Skindex-16 score varied by ≥ 10 points across all levels of OPGA scores. OPGA and Skindex-16 domain scores were moderately correlated (emotions ρ = 0.54, functioning ρ = 0.47, and symptoms ρ = 53). Longitudinal correlations were similar (emotion ρ xy = 0.54, functioning ρ xy = 0.65, symptoms ρ xy = 0.47). Visits with cspHRQL discordance occurred for each Skindex-16 domain (emotions = 7, functioning = 13, symptoms = 12). The ssgHRQL group was observed within the emotions (n = 1) and functioning (n = 23) domains. Median Skindex-16 scores are different between different levels of OPGA and show moderate cross-sectional and longitudinal correlation. This supports construct validity in patients with psoriasis. Severe discordance was rare and most often for those with clear skin but poor HRQL. These discordances can prompt further patient-clinician conversation.

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Differences in quality of life in patients with cutaneous lupus erythematosus with varying income levels

Cited by 6 publications

References 27 publications

Influence of Socio-Demographic Factors in Patients With Cutaneous Lupus Erythematosus

Influence of Socio-Demographic Factors in Patients With Cutaneous Lupus Erythematosus

Skin-Related Quality of Life During Autoimmune Bullous Disease Course

Evaluation of Skindex-16 construct validity in routinely collected psoriasis data: a retrospective analysis of the relationship between overall physician global assessment scores and Skindex-16 and measure discordance

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