Background/Purpose: Most persons with systemic lupus erythematosus (SLE) are women, and men with SLE are an understudied demographic. The purpose of this study was to characterize differences between men and women with SLE in a U.S. national cohort, including socioeconomic factors, disease manifestations, treatments, healthcare utilization and barriers to care, and to present racial variations in these characteristics by sex.

Methods: We conducted a retrospective, cross-sectional study of men and women with SLE in the U.S. National Institutes of Health All of Us Research Program, a national cohort of persons age ≥ 18 years with data repository consisting of participant survey and linked electronic health record (eHR) data. A participant from the All of Us Research Program was included as having SLE if there was any medical billing code for SLE in the eHR. We described and compared characteristics of men and women with SLE using Chi-squared, Fisher’s exact, and two-sample t-tests, as appropriate. Analyses encompassed SLE disease manifestations and treatments from eHR data and self-reported socioeconomic and lifestyle factors, including healthcare literacy, access, and utilization information, from surveys. A P value of ≤ 0.05 was considered statistically significant. We described racial variations in disease manifestations, treatments, and domains of healthcare literacy, access, and utilization stratified by sex.

Results: Of 2,893 persons with SLE, 325 (11%) were men. Men had significantly lower educational attainment and higher unemployment than women. Men reported significantly less fatigue. Compared to women with SLE, men demonstrated significantly more substance use, including more current and former tobacco smoking, and more ever marijuana and cocaine use. Total cardiovascular events, end-stage renal disease (ESRD), and antiphospholipid syndrome were significantly more common in men with SLE, and Raynaud’s phenomenon was significantly less common. Men were prescribed hydroxychloroquine, azathioprine and methotrexate significantly less often and tacrolimus significantly more often than women with SLE. Barriers to healthcare access and utilization were common in both men and women. Men had significantly less confidence in completing medical forms than women. Total cardiovascular events were common in men of all races.

Conclusion: Our study demonstrated major social, clinical and treatment differences in men and women with SLE. Socioeconomic factors acted as significant barriers to healthcare in both sexes. Men also reported less healthcare literacy, which may exacerbate pre-existing disparities. Refining our understanding of racial differences in men with SLE will require further large, prospective studies with a focus on recruiting men, who are underrepresented in this disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sex-and-racial-differences-in-systemic-lupus-erythematosus-among-u-s-adults-in-the-all-of-us-research-program/