Social Factors Impact Those with Lupus

Social determinants of health (SDH) are defined as the conditions in which people are born, grow, work, live, and age. In a new study, researchers found that unfavorable SDH conditions may lead to more severe lupus with increased risk of disease and mortality. It was also found that SDH conditions affect lupus management due to a variety of factors related to people’s life circumstances.

Researchers looked at a variety of published studies, specifically reviewing the impact of SDH on lupus presentation, management, and outcomes on a variety of factors, including:

Income

• Lower income and poverty are associated with multiple unfavorable outcomes for people with lupus, including increased disease activity, organ damage, mortality, depression, loss of work, decreased physical functioning and quality of life.
• Financial strain makes it challenging to treat and live with lupus, especially with competing demands like food and housing. Due to other stressors in their lives, people at lower income levels report only being able to manage their lupus during flares.

Education

• Lower educational attainment has been associated with poor lupus outcomes. In addition, lower educational attainment has also been associated with work loss, not taking medication as prescribed, missed doctor visits, lower health-related quality of life, lower physical functioning and increased depression and anxiety.
• Chronic diseases like lupus can make it challenging to perform work duties, and people who did not complete high school have an increased risk of disease activity and work disability.

Neighborhood factors

• Black people with lupus are 10 times more likely to live in disadvantaged neighborhoods than white people with lupus. In addition, neighborhood crime is a stressor that leads to higher disease activity.
• Living in rural areas is linked to higher disease activity, renal (kidney) disease, mucocutaneous (made up or involving the skin and mucous) and musculoskeletalmanifestations of lupus, and depression, likely due to poor access to specialized care.

Healthcare access

• People with lupus on public insurance (e.g. Medicare and Medicaid) have been shown to have higher rates of hospitalizations, readmissions, and healthcare fragmentation (receiving care across multiple places) than those on private insurance.

Discrimination

• Racism, especially in employment, housing, and medical settings, was associated with increased lupus activity and damage. Hearing about and observing racism also contributed to increased lupus activity.

Social support

• Low levels of social support are associated with adverse mental health and disease outcomes, as well as lower health quality of life and significantly more anxiety and depression.

Social determinants of health can play a significant role in lupus severity, impacting one’s ability to manage and cope with the condition. It is important to understand and address resulting health disparities in order improve the resources and quality of care for those with lupus. Learn more about health disparities and social determinants of health.

Read the study