Background/Purpose: Systemic Lupus Erythematous (SLE) disproportionately impacts black patients and those of low socioeconomic status who experience higher rates of kidney disease and premature mortality. Similar disparities are being addressed in HIV care by defining a care continuum starting with “retention in care.” Studies show that retention in care, defined as one visit or viral load every 6 months by CDC and WHO, correlates with viral suppression, an apt comparison for SLE care. Current SLE research is limited regarding factors that impact retention in care across diverse populations. The objectives of this study were to validate a cohort of patients with confirmed SLE to define retention in lupus care and examine its predictors.

Methods: Potential cases were identified from an academic urban medical center, with at least one ambulatory rheumatology encounter and an ICD code for SLE between 1/1/2013 and 6/30/2014. Inclusion required age > 17 years old, SLE diagnosis, and living through 2015. Manual record abstraction entered in Redcap system confirmed SLE diagnosis by the 1987 ACR or 2012 SLICC classification criteria. Abstraction included sociodemographics, tobacco use, first SLE diagnosis date, and 30 items examining ACR and SLICC criteria. Predictors examined included sociodemographic factors (age, sex, race, ethnicity), socioeconomic status (neighborhood poverty using a zip code area deprivation index [ADI]), number of SLE criteria, and health behavior data (tobacco use).

Retention in SLE care outcomes were defined using a variation of the WHO/CDC definitions in HIV requiring one ambulatory visit and one lab test (complement level) every 6 months. Multivariable logistic regression was used to model predictors using STATA v.15.0.

Results: A total of 397 individuals met ACR or SLICC classification criteria for SLE. Most were female (91%) and race varied (60% white, 40% black, 5% Hispanic). Overall, 60% met visit retention definitions, and 39% met complement lab testing definitions. There was no statistical difference seen with retention in care based on age, gender or race in either model. However, individuals residing in the most disadvantaged neighborhood areas (ADI quartile 4) were 60% less likely to have at least two clinic visits annually (Table 1). Data also showed 50% of black patients living in ADI quartile 4. Smoking history was also a negative predictor for visit retention.

Conclusion: Defining retention in lupus care is a critical step to meet the unmet need to identify and assist SLE patients at risk for gaps in care and outcome disparities. Race did not seem to predict retention; however, the most disadvantaged neighborhoods (ADI quartile 4) were a strong predictor of poor retention in care.  Future interventions could prospectively identify such at-risk populations and explore approaches such as multi-disciplinary care models to reduce care disparities.