Poverty and Race Play Roles in Lupus Patients’ Health Outcomes, Studies Suggest

Poverty and race can cast shadows over lupus patients’ health outcomes, according to two studies.

One study showed a connection between poverty and worse lupus-related health problems over time. The other showed that African-American and Hispanic women with lupus have higher rates of adverse pregnancy outcomes than whites.

The poverty-related study, “A Prospective Study of the Impact of Current Poverty, History of Poverty, and Exiting Poverty on Accumulation of Disease Damage in SLE,” was published in Arthritis & Rheumatology,

Dr. Edward Yelin of the University of California San Francisco and colleagues examined the connection between poverty and damage from systemic lupus erythematosus (SLE) over time. They looked at whether lupus patients were currently in poverty, how many years they had been poor, and whether they had been able to escape poverty.

Researchers did annual health interviews with 783 poverty-sticken lupus patients between 2003 and 2015. They used federal poverty criteria to categorize the patients as poor.

The team found a connection between a patient being in poverty in 2009 and a higher level of lupus-related organ damage in 2015.  An even starker finding was that patients who were in poverty every year between 2003 and 2009 had even greater organ damage.

Those who transitioned out of poverty had similar increases in organ damage than those who had never been poor, and much less damage than those who stayed poor, the team found.

“Persistent poverty and being poor in an area of concentrated poverty seem to worsen the amount of disease damage over time, while exiting poverty may alleviate it,” Yelin said in a news release. “We have also shown that chronic stress associated with poverty may play an important role in why the poor experience more damage. Such stresses may include having to deal with food, housing, and medical care insecurity.”

“Asking health care providers to reverse the strong currents battering the poor may be a very tall order,” he said. “Nevertheless, responsible clinicians do try hard to reduce the load on the poor with lupus.”

The race-related study, “Socioeconomic Status Contributes to Racial/Ethnic Disparities in Adverse Pregnancy Outcomes among Women with Systemic Lupus Erythematosus,” was published in Arthritis Care & Research.

Dr. Jane Salmon of the Hospital for Special Surgery in New York City and colleagues looked at the racial breakdown of adverse pregnancy outcomes in women with lupus. A key objective was to see if socioeconomic status could account for any differences.

The team used information from the PROMISE (NCT00198068) observational clinical trial. The multi-center study enrolled 408 lupus patients. Half were white, 20 percent African-American, 17 percent Hispanic, and 12 percent Asian or Pacific Islander. The measures of socioeconomic status the researchers used included educational attainment and median community income.

African-Americans and Hispanics with lupus had more than twice as many adverse pregnancy outcomes as white patients, the team found. Socioeconomic status was connected with African-Americans’ higher rate of adverse pregnancy outcomes, they found.

“However, we know of no studies to date that attempt to disentangle the factors that make up the race/ethnicity variable, such as socioeconomic status and genetics, when analyzing these disparities,” Salmon said.

“Additional work is needed to understand the potential sources of these disparities in pregnancy outcomes, and how and when to intervene to reduce disparities,” she added. “At present, we must be vigilant in educating and monitoring pregnant patients at increased risk of complications.”