COVID-19 Pandemic Widens Disparities Among People with Rheumatic Diseases, Lupus
Data from multiple public health departments highlight that the COVID-19 pandemic is increasing health disparities among people with rheumatic diseases, such as lupus. The virus disproportionately affects Black, Hispanic, American Indian, and lower socioeconomic status individuals. Known disparities raise significant concern for vulnerable patients in terms of short-term infection risk and both short- and long-term control of their lupus.
- Many of these individuals have more severe flares and their disease is less well controlled, plus may not be able to follow social distancing recommendations due to crowded or unstable living situations and financial constraints.
- Unable to access high quality outpatient care, they may also experience more frequent glucocorticoid use, heightening infection risk and causing cardiovascular disease and diabetes which are known risk factors for poorer outcomes from COVID-19.
Physicians are acutely aware of the higher COVID-19 morbidity and mortality, as well as higher infection rates among racial/ethnic minorities and individuals of lower socioeconomic status for persons with rheumatic diseases. Comorbidities are frequent, timely access to subspecialty care is limited, receipt of high-quality care is less common, and care is more often fragmented with frequent and avoidable use of emergency care.
These disparities have been shown to be particularly pronounced in people with lupus, among whom prolonged glucocorticoid use and delayed or lack of standard-of-care immunosuppressive use is common, and hydroxychloroquine (HCQ) is under-prescribed and adherence is suboptimal.
- Compared to white individuals, Black people have at least a 2-3x higher prevalence of lupus, significantly poorer outcomes and are much less likely to be enrolled in clinical trials.
- Racial discrimination has also been associated with increased rheumatic disease activity and greater organ damage.
- Insufficient supplies of essential medications, like HCQ, combined with potentially more severe disease and delays to initial care, will likely result in significantly poorer outcomes and widening disparities months down the road when these same individuals are unable to get their medication refilled.
The researchers call for more partnerships across healthcare providers, academic institutions, community members and policy leaders to better understand the acute needs of rheumatology patients, build trust and to intervene and prevent the avoidable widening of racial, ethnic, and socioeconomic disparities in the setting of COVID-19. The study authors outline six approaches to address disparity:
- Collect and release sociodemographic data both in the clinical and research setting.
- Engage in advanced care planning conversations with patients.
- Ensure racial/ethnic diversity in clinical trial enrollment and understand confounding factors in observational studies.
- Support rheumatology-related disparities research.
- Recognize and address the inequities in access to care during this pandemic.
- Advocate for patients by partnering with rheumatic disease-specific organizations, city, state, national and international organizations, and community-based networks to ensure that all patients, including the most vulnerable, are able to access the medication and healthcare that they need during this time of crisis and after.
The authors conclude that in addition to clinical care, healthcare providers and researchers must also work together to achieve equity in health. Through a comprehensive program of research, education, and advocacy, the Lupus Foundation of America (LFA) leads the fight to improve the quality of life for all people affected by lupus. To date, LFA advocacy efforts have secured nearly $17 million for the Lupus Program at the Office of Minority Health, a federal agency dedicated to improving the health of racial and ethnic minority populations through the development of policies and programs that will help eliminate racial health disparities.
Learn more about coronavirus and lupus.