Race and Social Determinants of Health Influence Low Lupus Disease Activity in Children with Childhood-Onset Systemic Lupus Erythematosus

In a new study, researchers examined children with childhood-onset systemic lupus erythematosus (cSLE) and the association between race and social determinants of health (SDOH) on the individual or neighborhood-level with achievement of modified low lupus disease activity state (mLLDAS, a clinically relevant treatment target associated with a higher health-related quality of life and less disease damage). 

This study utilized the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry which included 540 children with cSLE. Of the study participants, 27% identified as Black, 25% White, 23% Latino/a, 11% Asian, 9% of more than one race, and 5% other. Researchers evaluated LLDAS, disease activity and included individual insurance status (e.g. private, public), and neighborhood-level area deprivation index (ADI) SDOH. ADI is comprised of 17 different census measures from social domains including income, poverty, employment, education, and housing among others. 

Researchers found that living in areas of higher ADI may be linked to increased renal disease and prednisone exposure. Moreover, children who self-reported Black race and those identifying with more than one race had lower rates of LLDAS achievement compared to White children. Furthermore, Black children exhibited higher disease activity over time, independent of renal disease, ADI, or insurance status compared to White children, suggesting that there are other measures impacting racial disparities in cSLE. The factors may include changes in gene expression due to psychosocial stressors in the sociocultural environment. 

Further work is needed to identify and address disparities among people living with lupus, and to ensure those of racial or ethnic background receive equitable opportunities to experience optimal health outcomes. Former Gary S. Gilkeson Career Development Awardee Joyce Chang, MD, MSCE is a co-author of the study. Learn more about the impact of lupus in children and teens and health disparities in lupus.

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