Lupus Disease Activity and Organ Damage Varies by Socioeconomic Status in Black Women

Differences in socioeconomic status and economic stability can disproportionately affect racial/ethnic groups that have been marginalized. These effects can be even more compounded for people who live with lupus. In a new study, researchers examined systemic lupus erythematosus (SLE) inequities by identifying sociodemographic risk profiles associated with organ damage overtime, specifically among Black women with SLE. The researchers discovered social inequities likely contribute to racial inequities in SLE disease progression rather than biological differences in disease risk. Those with fewer socioeconomic resources and uncontrolled SLE were at higher risk for increasing disease severity overtime. 

The profiles of 438 women with SLE participating in the Black Women’s Experiences Living with Lupus (BeWELL) study were studied. Over a two-year period, researchers examined associations of demographic, socioeconomic, and health characteristics, and the timing and degree of organ damage overtime to create various profiles. Four profiles emerged: 

1. Younger/Lower socioeconomic standing with uncontrolled SLE 
   1. Characterized by indicators of low socioeconomic standing, moderate SLE severity and uncontrolled disease activity. This group had the lowest income-to-poverty ratio and 69% reported being unable to work due to SLE. This group saw high disease activity, moderate levels of organ damage and high rates of glucocorticoid (72.96%) and hydroxychloroquine (81.63%) use. 
2. Older/Lower socioeconomic standing with uncontrolled SLE 
   1. This group is characterized as older and have been living with SLE the longest, as well as have a high income-to-poverty ratio. These women had the highest levels of organ damage at baseline, with 82.24% unable to work, 76.64% on public insurance, and 82.24% did not have a college degree. This group reported lower use of glucocorticoids, hydroxychloroquine, and immunosuppressants compared to other groups. 
3. Mid-socioeconomic standing with controlled SLE 
   1. Characterized as working-class with moderate socioeconomic resources and low disease severity. Participants (93.03%) were working either full-time or part time and many were educated. Baseline levels of organ damage were the lowest among this group, which also had lower levels of disease activity. 
4. Higher socioeconomic standing with controlled SLE 
   1. This group is characterized by high levels of socioeconomic resources, with 57.14% college educated, 65.31% working full time, and 77.55% on private insurance. Moderate levels of SLE severity and lower disease activity than profiles 1 + 2. 

This study demonstrates that timing and extent of organ damage overtime varies by socioeconomic profile. More research is needed on sociodemographic predictors of racial inequities and organ damage. 

Learn more about health disparities and social determinants of health and the Lupus Foundation of America’s work through its Lupus AIM (Addressing health Inequities in Minorities) program.

Read the study