In the JournalsPerspective

Extent of disease damage cited as factor for higher mortality among impoverished patients with SLE

Results from this study highlighted greater disease damage as a principal factor in increased mortality rates among low-income patients with systemic lupus erythematosus.

Edward Yelin

“Preventing disease damage from worsening is not an easy task, made more so by the fact that the reasons the poor experience greater damage includes inadequate access to high quality care, but also extends to the stress associated with facing food, housing and medical insecurity and living in neighborhoods that are inherently stressful,” study co-author Edward Yelin, PhD, told Healio Rheumatology.

Yelin and colleagues performed their analysis using 807 patients with SLE identified from the University of California, San Francisco Lupus Outcomes Study in 2009. Investigators determined the impact of poverty on the risk of mortality and examined mortality with and without adjusting findings for demographics. They also determined the impact of other variables such as demographics; lupus status, including the extent of disease damage; overall health status; health behaviors and health care characteristics. 

Results showed that by 2015, 71 patients had died. Of these, 57 patients were not poor and 14 patients were poor, as defined as having a household income of no more than 125% of the federal poverty level. Of the patients who died, poor patients lived 13.9 fewer years compared with patients who were not poor. Investigators noted poverty status in 2009 correlated with a greater chance of mortality after they adjusted findings for age. However, poverty was no longer correlated with a greater risk for mortality after investigators adjusted for the extent of disease damage and age.

“The results indicate that understanding why the poor experience higher levels of disease damage may reduce mortality among this group,” the researchers wrote. – by Monica Jaramillo

 

Disclosure: The study received grant support from the Robert Wood Johnson Investigator in Health Policy Awards (NIAMS P60 AR-053308, 2R01-AR-056476 and NIAMS K23 AR-060259).

Results from this study highlighted greater disease damage as a principal factor in increased mortality rates among low-income patients with systemic lupus erythematosus.

Edward Yelin

“Preventing disease damage from worsening is not an easy task, made more so by the fact that the reasons the poor experience greater damage includes inadequate access to high quality care, but also extends to the stress associated with facing food, housing and medical insecurity and living in neighborhoods that are inherently stressful,” study co-author Edward Yelin, PhD, told Healio Rheumatology.

Yelin and colleagues performed their analysis using 807 patients with SLE identified from the University of California, San Francisco Lupus Outcomes Study in 2009. Investigators determined the impact of poverty on the risk of mortality and examined mortality with and without adjusting findings for demographics. They also determined the impact of other variables such as demographics; lupus status, including the extent of disease damage; overall health status; health behaviors and health care characteristics. 

Results showed that by 2015, 71 patients had died. Of these, 57 patients were not poor and 14 patients were poor, as defined as having a household income of no more than 125% of the federal poverty level. Of the patients who died, poor patients lived 13.9 fewer years compared with patients who were not poor. Investigators noted poverty status in 2009 correlated with a greater chance of mortality after they adjusted findings for age. However, poverty was no longer correlated with a greater risk for mortality after investigators adjusted for the extent of disease damage and age.

“The results indicate that understanding why the poor experience higher levels of disease damage may reduce mortality among this group,” the researchers wrote. – by Monica Jaramillo

 

Disclosure: The study received grant support from the Robert Wood Johnson Investigator in Health Policy Awards (NIAMS P60 AR-053308, 2R01-AR-056476 and NIAMS K23 AR-060259).

    Perspective
    Monica Richey

    Monica Richey

    In this study, the authors concluded the “principal way that poverty results in higher mortality in SLE is by increasing the extent of damage accumulation.” However, the results did not shed any light on where the increased damage comes from. Previous articles also have looked into this conundrum. Thus far, we know low socioeconomic status, gender, education, access to care and race all play a role on the severity of lupus. However, which one has the biggest impact remains to be seen.

    The demographics of this study mirror previous well-known facts. Poor patients had a higher mortality rate and lived 13.9 fewer years than non-poor patients. They were more likely to be younger, from a racial minority, have a high school education or less and be unmarried. The most significant fact was that in the poor group “fewer than a fifth had received care consistent with the published benchmark of 85% or more of quality indicators for SLE.” Is access to care where X marks the spot?

    More targeted research is necessary to pinpoint what is the true denominator when it comes to lupus outcomes. In the meantime, lupus patients must have prompt access to treatment and rheumatology providers. That, in itself, already wins half of the battle with the beast.

    • Monica Richey, MSN, ANP-BC/GNP
    • Nurse practitioner Division of rheumatology at Northwell Health  New York

    Disclosures: Richey reports no relevant financial disclosures.