A multiethnic, multicenter cohort of patients with systemic lupus erythematosus (SLE) as a model for the study of ethnic disparities in SLE
Article first published online: 30 APR 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 4, pages 576–584, 15 May 2007
How to Cite
Fernández, M., Alarcón, G. S., Calvo-alén, J., Andrade, R., McGwin, G., Vilá, L. M., Reveille, J. D. and LUMINA Study Group (2007), A multiethnic, multicenter cohort of patients with systemic lupus erythematosus (SLE) as a model for the study of ethnic disparities in SLE. Arthritis & Rheumatism, 57: 576–584. doi: 10.1002/art.22672
- Issue published online: 30 APR 2007
- Article first published online: 30 APR 2007
- Manuscript Accepted: 23 AUG 2006
- Manuscript Received: 28 APR 2006
- NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Grant Number: R01-AR42503
- General clinical Research Centers to the University of Texas Health Science Center at Houston. Grant Number: M01-RR02558
- University of Alabama at Birmingham. Grant Number: M01-RR00032
- RCMI Clinical Research Infrastructure Initiative to the University of Puerto Rico. Grant Number: Award 1-P20-RR-11126
- Mary Kirkland Scholar Award Program
- Fellowships from Rheuminations, Inc. (University of Alabama at Birmingham)
- Systemic lupus erythematosus;
To examine health disparities as a function of ethnicity using data from LUpus in MInorities, NAture versus nurture (LUMINA), a longitudinal study of patients with systemic lupus erythematosus (SLE); to build an explanatory model of how ethnic disparities occur in this setting; and to suggest appropriate interventions.
LUMINA patients (meeting American College of Rheumatology criteria for SLE) ages ≥16 years of African American, Hispanic (from Texas), Hispanic (from Puerto Rico), or Caucasian ethnicity were studied. In addition to examining the basic features of the cohort, we examined, by univariable and multivariable analyses, the factors associated with disease activity, damage accrual, lupus nephritis, and mortality. An empiric model based on the data presented (and the literature reviewed) was derived to explain the disparities observed.
There were substantial differences in the socioeconomic/demographic, clinical, and genetic features among patients from the different ethnic groups, with Texan Hispanic and African American patients exhibiting overall a lower socioeconomic status, different genetic associations, more serious disease at a younger age, and worse intermediate and final outcomes than the Caucasian and Puerto Rican Hispanic patients. A model of disease outcome as a function of the disparities observed was created.
Ethnic disparities occur in SLE. Environmental, socioeconomic/demographic, psychosocial, genetic, and clinical factors play an important role as determinants of the ethnic differences observed. Measures aimed at eliminating these disparities are suggested while further research is conducted to elucidate the basis of these disparities and their changes at the societal level and to eliminate the gap between the rich and the poor.