Background/Purpose: Systemic lupus erythematosus (SLE) is variable in clinical presentation and has fluctuating disease severity. Health outcomes in SLE have been linked to both genetic and social factors related to differences in gender, ethnicity, education, income, and occupation. This cross-sectional study aims to evaluate the relationship between the access to primary care, social determinants of health (SDH), and disease outcome a single Canadian tertiary center.

Methods: Patients with 2019 EULAR/ACR SLE diagnosis were recruited consecutively and informed consent obtained after ethics board approval. Information on patient demographics, SDH and quality of life (Lupus QoL) was collected through a Patient Questionnaire. A chart review was conducted to document disease activity by SLE-Disease Activity Index (SLEDAi-2k) at the consenting visit, emergency department visits, ACR damage index and adverse outcomes.

Results: 93 patients with a confirmed diagnosis of SLE have been recruited and analyzed at this interim stage. 87.1% (n=81) had access to a General Practionner (GP group) and 12.9% (n=12) did not have access to a GP (Non-GP group). The Non-GP group had a mean SLEDAI-2K score of 4.2 ± 4.9 compared to 2.6 ± 3.6 in the GP group (p=0.21). The SLICC/ACR Damage Index score was 0.7 ± 1.2in Non-GP group and 1.2± 1.6 in GP group (p=0.21). Lupus QoL was similar with 61.2±20.5 compared to 64.8±19.5 (p=0.49) for the Non-GP group compared to GP group respectively. History of lupus related pregnancy complications were more frequent in non-Caucasian participants (32.4% vs 9.4%, p=0.010) compared to Caucasians and with a trend to occur more frequently in the Non-GP group (33.3% vs 15.8%). Compared to Caucasians, more oral corticosteroids use was seen in the non-Caucasian group (51.4% vs 22.6% p=0.010), but similar rates of cardiovascular events and major infections.There is a trend, but not statistically significant, towards more osteoporosis in the non-Caucasian group (13.5% vs 1.9%) and a trend towards more fractures in that group (8.1% vs 0%). Equal rates of employment, education, smoking and emergency visits were recorded between GP an non-GP groups as well as between non-Caucasian and Caucasians.

Conclusion: Our interim results suggests that there remain discrepancies in health outcomes in our SLE cohort, despite our universal health care system. Preliminary results suggest SLE patients without access to primary care and non-Caucasians may have an increased risk of pregnancy complications, increased corticosteroid use and more osteoporosis. The sample size is small, and the study is ongoing. Further multivariate analysis is planned to elaborate on health determinants.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disparity-in-healthcare-in-systemic-lupus-erythematosus-a-single-center-study/