Health disparities in systemic lupus erythematosus-a narrative review

Abstract

Purpose of review: To describe root causes of health disparities by reviewing studies on incidence and outcomes of systemic lupus erythematosus (SLE) related to ethnic, race, gender, or socioeconomic differences and to propose solutions.

Recent findings: SLE outcomes have steadily improved over the past 40 years but are not uniformly distributed across various racial and ethnic groups. Belonging to racial and ethnic minority has been cited as a risk factor for more severe disease and poor outcome in SLE. Population-based registries have demonstrated that Black patients with SLE have significantly lower life expectancy compared to White patients. Lower socioeconomic status has been shown to be one of the strongest predictors of progression to end stage renal disease in lupus nephritis. An association between patient experiences of racial discrimination, increased SLE activity, and damage has also been described. The lack of representation of marginalized communities in lupus clinical trials further perpetuates these disparities. To that end, the goal of a rheumatology workforce that resembles the patients it treats has emerged as one of many solutions to current shortfalls in care. Disparities in SLE incidence, treatment, and outcomes have now been well established. The root causes of these disparities are multifactorial including genetic, epigenetic, and socioeconomic. The underrepresentation of marginalized communities in lupus clinical trials further worsen these disparities. Efforts have been made recently to address disparities in a more comprehensive manner, but systemic causes of disparities must be acknowledged and political will is required for a sustained positive change.

Keywords: Clinical trials; Disparities; Epidemiology; SLE.

Fig. 1

Overview of effects of systemic racism on disparities in SLE outcomes. Ingrained systemic racism in society involves a system where ethnic minorities have higher rates of poverty and unequal access to housing and education. This can have both indirect and long-term effects such as unequal healthcare access and elevated stress levels leading to a proinflammatory state. Figure 1 demonstrates how systemic racism can ultimately lead to disparities in SLE outcomes

Fig. 2

Solutions and strategies. Various strategies have been employed at both individual and community levels to address health disparities in SLE. Technology-based strategies are now increasingly being used for minority recruitment in clinical trials and in improving healthcare access