Outcomes/Effectiveness Research

Lower socioeconomic status results in poor physical and mental health outcomes for patients with lupus

Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly affects women. Patients with SLE have twice the risk of dying compared to the general population. Socioeconomic status (SES) of patients—as well as their neighborhoods—can impact SLE outcomes.

Researchers from the University of California San Francisco found that patients with SLE who also are in low SES have worse physical functioning and more depressive symptoms. They looked at data from the Lupus Outcomes Study, which surveyed 957 patients with SLE over the telephone. Questions were asked about symptoms, physical functioning, and signs of depression. In addition, SES was determined for each patient as well as for the neighborhood where they lived. Most of the participants were female (91 percent) and white (66 percent), with equal numbers of blacks, Asians, and Hispanics.

Three factors were associated with increased disease activity: lower education level, lower income level, and poverty status. The study demonstrated a consistent and significant association between lower SES and poorer physical functioning. It was also linked to a higher rate of depressive symptoms. Patients who were poor and living in high poverty neighborhoods had a depression rate of 76 percent compared with 32 percent of patients who were neither poor nor living in poverty areas. The rates of depressive symptoms remained significantly higher for residents of high poverty areas, even when the researchers controlled for education, household income, or household poverty status.

Based on this finding, the researchers suggest that clinicians take into consideration a patient's residential environment when planning optimal care for SLE. The study was supported in part by the Agency for Healthcare Research and Quality (HS13893).

See "The role of neighborhood and individual socioeconomic status in outcomes of systemic lupus erythematosus," by Laura Trupin, M.P.H., M. Christine Tonner, M.P.H., Jinoos Yazdany, M.D., M.P.H., and others, in the September 2008 Journal of Rheumatology 35(9), pp. 1782-1788.

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