Background/Purpose: Careful assessment of individuals’ social determinants of health (SDOH) that affect systemic lupus erythematosus (SLE) is crucial, as such evidence will improve care and hence reduce health disparities for patients with SLE, especially for those who are most vulnerable and at highest risk.

Methods: We conducted a retrospective population-based study using Medical Expenditure Panel Survey data for 2017-2021. Patients with SLE were identified using ICD-10 of M32 and had SLE-related medication use and/or a visit to a rheumatologist in the survey year. We matched eight patients without SLE to each SLE patient on survey year, age, and gender, to generate a reference cohort. SDOH domains included economic stability (ES), education, healthcare access and quality (HAQ), social and community context (SCC), and neighborhood and built environment (NBE). We conducted separate adjusted logistic regressions to examine the association between each SDOH and SLE, controlling for confounders.

Results: In the unadjusted analyses for the ES domain, the odds of SLE were significantly higher in those with very low food security, who used food stamps, who were unemployed, and who had poor to near poor income compared to their respective counterparts (p< 0.05). For the SCC domain, non-Hispanic Black (NHB) patients had higher odds of SLE than non-Hispanic White (NHW) patients, while for the NBE domain, those with no physical activity and with any psychological distress had higher odds of SLE. In the HAQ domain, those with Medicaid, with transportation issues getting to the provider, and with unmet prescription needs had higher odds of SLE than their respective counterparts (p< 0.05). In the adjusted analysis, in the ES domain, those with poor family income showed higher odds of SLE than those with high family income (adjusted odds ratio (AOR)=2.779, p< 0.05). Within the SCC domain, NHB patients (AOR=2.429, p< 0.05) and Hispanic patients (AOR=1.616, p >0.05) had higher odds of SLE than NHW patients. Within the NBE domain, patients with any psychological distress (AOR=2.127, p< 0.05) and those who had no physical activity (AOR=1.677, p< 0.05) had higher odds of SLE. Within the HAQ domain, those with Medicaid insurance (AOR=2.540, p< 0.05) and with transportation issues getting to a provider (AOR=20.394) had higher odds of SLE than their respective counterparts. Also, patients in the highest SDOH burden quartile had significantly higher odds of SLE (AOR=2.039, p< 0.05) than those in the lowest SDOH burden quartile.

Conclusion: Our study highlighted several subgroups of patients, especially those with higher social disadvantage and a higher SDOH burden. The prevalence of SLE increased with a higher SDOH burden.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-social-determinants-of-health-with-systemic-lupus-erythematosus-in-the-united-states-nationally-representative-estimates-for-2017-2021/