Health disparities in systemic lupus erythematosus—a narrative review

Abstract

Purpose of review To describe root causes of health disparities by reviewing studies on incidence and outcomes of systemic lupus erythematosus (SLE) related to ethnic, race, gender, or socioeconomic differences and to propose solutions. Recent findings SLE outcomes have steadily improved over the past 40 years but are not uniformly distributed across various racial and ethnic groups. Belonging to racial and ethnic minority has been cited as a risk factor for more severe disease and poor outcome in SLE. Population-based registries have demonstrated that Black patients with SLE have significantly lower life expectancy compared to White patients. Lower socioeconomic status has been shown to be one of the strongest predictors of progression to end stage renal disease in lupus nephritis. An association between patient experiences of racial discrimination, increased SLE activity, and damage has also been described. The lack of representation of marginalized communities in lupus clinical trials further perpetuates these disparities. To that end, the goal of a rheumatology workforce that resembles the patients it treats has emerged as one of many solutions to current shortfalls in care. Summary Disparities in SLE incidence, treatment, and outcomes have now been well established. The root causes of these disparities are multifactorial including genetic, epigenetic, and socioeconomic. The underrepresentation of marginalized communities in lupus clinical trials further worsen these disparities. Efforts have been made recently to address disparities in a more comprehensive manner, but systemic causes of disparities must be acknowledged and political will is required for a sustained positive change.

Local Ancestry at the Major Histocompatibility Complex Region is Not a Major Contributor to Disease Heterogeneity in a Multiethnic Lupus Cohort

“…The absence of differences in local ancestry according to the presence versus absence of more severe disease manifestations suggests that local ancestry is not a large contributor to the observed differences in SLE manifestation severity in African American and Mestizo patients in this study. Although some studies have suggested that genetics may be responsible for the observed differences, recent studies suggest that social determinants of health are a large contributor to these differences 19 …”

“…Although some studies have suggested that genetics may be responsible for the observed differences, recent studies suggest that social determinants of health are a large contributor to these differences. 19 A major strength of our study was the use of a clinically wellcharacterized multiethnic patient with SLE cohort allowing for analyses to extend beyond populations of European descent. Although SLE is more prevalent and severe in African American and Mestizo populations, multiethnic studies are lacking.…”

Diversity and disparity in the treatment and care of sarcoidosis

“…Addressing disparity in sarcoidosis requires a multipronged approach (Fig. 2) [94]. This approach identifies the factors known to influence health disparity within a specific setting and provides solutions that can be implemented at the patient, physician, and legislative level (Table 2).…”

Improving Outcomes in Systemic Lupus Erythematosus: The Importance of Access to Medications

“…SLE disproportionately affects women and racial or ethnic minority populations, and health disparities have been described for SLE incidence, prevalence, outcomes, and mortality. 1 The most significant contributor to mortality overall in SLE is the presence of renal disease, and renal disease is more common in racial and ethnic minorities. 1 Renal disease also necessitates more aggressive management with immunosuppressant medications.…”