For Black women with SLE, racial discrimination tied to inflammation
Participants included 380 Black women with SLE enrolled in BeWELL study
Racial discrimination was found to be associated with increased inflammation among Black women with systemic lupus erythematosus (SLE) in a recent study.
Each experience of racial discrimination was tied to a nearly 4% increase in the levels of C-reactive protein (CRP), an inflammation marker, in the bloodstream, the findings indicated.
“This study contributes to the growing body of evidence on the biological consequences of racial discrimination,” Tamika Webb-Detiege, MD, a rheumatologist at the University of Queensland in Louisiana and one of the study’s authors, said in a press release. “Understanding how racial discrimination compromises health and inflammatory pathways is crucial in our pursuit of more equitable and just outcomes for our communities.”
SLE is an autoimmune disease marked by immune-mediated inflammation and damage to various tissues and organs, including the skin, brain, heart, lungs, kidneys, and joints.
Black women in the U.S. have the highest prevalence of it, experience more severe disease, and have an increased risk of mortality in general and at an earlier age than white women. These differences in disease progression and outcomes aren’t rooted in behavioral or genetic factors, but in social inequities, emerging evidence suggests.
Racial discrimination’s effect on inflammation in SLE
To investigate further, the researchers examined whether racial discrimination impacts CRP levels in Black women with SLE over two years.
The participants included 380 Black women with confirmed SLE who lived in Atlanta, Georgia and were enrolled in the Black Women’s Experiences Living with Lupus (BeWELL) Study. Their average household income was about two times the federal poverty threshold, in the near-poor range. The women had a mean age of about 47 and had been living with SLE for a mean of nearly 16 years.
CRP levels were measured in dried blood spots at the study’s start (baseline), as well as after one and two years. The Experiences of Discrimination (EOD) questionnaire was used to assess racial discrimination. It includes nine domains where racial discrimination may be experienced — at school, getting a job, at work, housing, seeking and receiving medical care, getting service at store or restaurant, obtaining credit, bank loans, or a mortgage, in a public setting, or with the police/courts.
At baseline, most participants (81.48%) reported at least one experience of racial discrimination in their lifetime in any of the nine domains. About 55% reported a new instance of discrimination at one year and 52% between the first and the second year of follow-up. Generally, the prevalence of racial discrimination in the study was similar to overall lifetime experiences reported at baseline.
Racial discrimination was most commonly experienced as slights and biases either in a store or restaurant or a public setting. Less common experiences occurred in institutional settings such as school, getting a job or housing, or from the police or courts.
At baseline, CRP levels weren’t associated with lifetime experiences of racial discrimination after controlling for baseline lifetime discrimination, baseline CRP levels, and other factors. Similarly, discrimination experienced in the first year of follow-up wasn’t significantly associated with CRP levels measured in the first and second year of follow-up.
Racial discrimination experienced between the first and the second year of follow-up was significantly associated with CRP levels at year two after adjustments, however.
Greater lifetime experiences of discrimination reported at baseline were associated with more reports of discrimination in the first year, which predicted discrimination in the second year.
Lastly, researchers found that experiences of racial discrimination were associated with annual changes in CRP levels over two years, which corresponded to a nearly 4% increase in CRP levels for each EOD domain.
“The results of this study contribute to a growing body of evidence indicating that racial discrimination is a toxic health threat and that the embodiment of racial discrimination is one pathway through which racism contributes to inequitable health outcomes for Black Americans,” the researchers wrote. “Policies and laws aimed at eliminating contemporary and persistent forms of racial discrimination are likely to advance health equity for Black women with SLE, as well as Black Americans more broadly.”