The 1000 Canadian Faces of Lupus: Determinants of Disease Outcome in a Large Multiethnic Cohort

Peschken, Christine A.; Katz, Steven J.; Silverman, Earl D.; Pope, Janet; Fortin, Paul R.; Pineau, Christian; Cd, Smith; Arbillaga, Hector; Gladman, Dafna D.; Urowitz, Murray B.; Zummer, Michel; Clarke, Ann E.; Bernatsky, Sasha; Hudson, Marie

doi:10.3899/jrheum.080912

Cited by 110 publications

(129 citation statements)

References 48 publications

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“…6 Another study demonstrated a positive association of antiphospholipid antibodies in 'Aboriginal' Canadians with SLE, compared with persons of Asian or European descent. 7 Our anecdotal experience indicates that discoid lesions (either isolated or in the setting of SLE), are more severe in nonwhite individuals; however, this has not as yet been confirmed by published studies in persons of African descent. 8 Any apparent observed differences in frequency, severity and/or phenotypic expression of SLE between persons of different ethnic backgrounds may be due to constitutional (genetic), environmental (including cultural) factors, or a combination thereof.…”

Section: Lupus Erythematosusmentioning

confidence: 63%

“…This study concluded that factors linked to lower income and socioeconomic status, is an independent risk factor in multivariate analysis, rather than ethnicity per se. 7,[9][10][11][12][13] Poor access to healthcare systems, high cost of health services, difficulties in adhering to treatments, as well as difficulties coping with the disease may all affect disease progression and outcome. Furthermore, ethnic minorities are more likely to be exposed to noxious substances such as tobacco and this, in combination with other social factors, may contribute to the observed worse prognosis of SLE in this cohort of patients.…”

Section: Lupus Erythematosusmentioning

confidence: 99%

See 1 more Smart Citation

Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease

Petit

Dadzie

2013

Br J Dermatol

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Section: Lupus Erythematosusmentioning

confidence: 63%

Section: Lupus Erythematosusmentioning

confidence: 99%

Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease

Petit

Dadzie

2013

Br J Dermatol

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“…Compared with Caucasians, the prevalence of SLE is higher among North American Indians, African-Americans, African-Caribbeans, Hispanics and Asians. [8][9][10][11]19,[26][27][28][29][30] In IA, the reported prevalence of SLE varies from 52.6 to 92.8 per 100 000 people, a prevalence two to four times higher than that of Caucasians (Table 1). [12][13][14][15][16] In Far North Queensland, SLE prevalence in IA was 92.8 per 100 000 persons, twice that of the generally European descended population (45.3 per 100 000 persons).…”

Section: Sle In Indigenous Australiansmentioning

confidence: 99%

Focus on systemic lupus erythematosus in Indigenous Australians: towards a better understanding of autoimmune diseases

Vincent

Bourke

Morand

et al. 2013

Internal Medicine Journal

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The incidence and prevalence of autoimmune diseases such as rheumatoid arthritis, primary Sjögren syndrome, scleroderma and systemic lupus erythematosus (SLE) varies with geography and ethnicity. For example, SLE is reported to be more common in populations such as African‐Caribbeans and Indigenous Australians (IA). As well as socio‐economic status, variation in severity of disease may also show ethnic variability. The initial presentation of SLE in IA, in the context of a unique genetic background and distinctive environmental influences, is often florid with a recurring spectrum of clinical phenotypes. These clinical observations suggest a unique pathway for autoimmunity pathogenesis in this population. For instance, the high prevalence of bacterial infections in IA, particularly group A streptococcus, may be a potential explanation not only for increased incidence and prevalence of SLE but also the commonly florid acute disease presentation and propensity for rapidly progressive end organ threatening disease. This article will review the state of research in autoimmune disease of IA, consider key findings related to autoimmune disease in this population and propose a model potentially to explain the involvement of innate immunity and chronic infection in autoimmune disease pathogenesis. Ultimately, understanding of SLE at this level could affect management and result in personalised and targeted therapies to improve the health status of IA as well as better understanding of SLE pathogenesis per se.

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“…Important health disparities, including higher renal complications and mortality rates, have been noted in groups defined by low socioeconomic status, black race, Hispanic ethnicity, or Asian ethnicity (1,3,(10)(11)(12). Prior reports from US referral cohorts representing some of these vulnerable populations are criticized for missing mild cases and patients with limited access to care.…”

mentioning

confidence: 99%

Editorial: Updates in US Systemic Lupus Erythematosus Epidemiology: Tales of Two Cities

Bartels

Ramsey‐Goldman

2014

Arthritis & Rheumatology

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While contemporary US and international systemic lupus erythematosus (SLE) consortia (1-3) have greatly advanced our knowledge regarding the disease, many argue that such registries suffer from referral bias and do not accurately represent the spectrum of disease at the population level. In contrast, population-based cohort studies encompass the spectrum of mild through severe cases of SLE and can estimate incidence and prevalence. Yet identifying the full range of cases for this disease across a given population requires multiple data sources with precisely interpreted clinical, laboratory, and even pathology data. These factors have made SLE one of the most challenging diseases to research through epidemiologic or administrative data (4). Moreover, the few existing US population-based SLE cohorts summarized in a 2009 review (5) are now largely outdated or had described SLE prevalence and incidence rates in small, homogeneous, geographic regions (6,7). Those studies reported widely varying rates of SLE, likely related, at least in part, to differences in methodology. Updating contemporary lupus population-based epidemiology is critically important to framing the current public health burden and status of SLE care in the US.SLE is a disease with substantial direct and indirect costs over the patient's lifespan (8,9) and with well-known health disparities. Important health disparities, including higher renal complications and mortality rates, have been noted in groups defined by low socioeconomic status, black race, Hispanic ethnicity, or Asian ethnicity (1,3,10-12). Prior reports from US referral cohorts representing some of these vulnerable populations are criticized for missing mild cases and patients with limited access to care. To include such cases, it is important to have a broad definition of case ascertainment and to search multiple points of entry into the health care system, ranging from tertiary centers to community clinics and hospitals, or even laboratory and pathology services. To date, the lack of a comprehensively defined population-based "denominator" to accurately represent the number of SLE cases in the US has limited our ability to answer many important questions. For example, without accurate numbers of existing SLE cases, it has been difficult to adequately quantify the burden of SLE in the US, let alone reassess health disparities and SLE quality of care on a population level (13).Two reports in this issue of Arthritis & Rheumatology, one by Lim et al (14) and the other by Somers et al (15), describe collaborative studies offering muchneeded updates on the epidemiology of SLE in the US. Among the key contributions of their work are the pivotal partnerships with the Centers for Disease Control and Prevention (CDC) and their respective state health departments. These groups cooperated under a state public health surveillance exemption to Health Insurance Portability and Accountability Act (HIPAA) to facilitate comprehensive regional searches for SLE cases. Both groups of investigators ascert...

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The 1000 Canadian Faces of Lupus: Determinants of Disease Outcome in a Large Multiethnic Cohort

Abstract: There are differences in lupus phenotypes between ethnic populations. Although ethnicity was not found to be a significant independent predictor of damage accrual, low income was.

Cited by 110 publications

References 48 publications

Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease

Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease

Focus on systemic lupus erythematosus in Indigenous Australians: towards a better understanding of autoimmune diseases

Editorial: Updates in US Systemic Lupus Erythematosus Epidemiology: Tales of Two Cities

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