Background/Purpose: Management of patients with SLE should consider social determinants of health (SDoH) and their impact on access, treatment, and patient outcomes; however, such a holistic approach is not routinely studied or adopted in clinical practice.1 To close this knowledge gap, we assessed patient characteristics including SDoH, disease burden and clinical outcomes, and healthcare resource use (HCRU) among adult Medicare Advantage (MA) plan enrollees with SLE.

Methods: This retrospective analysis (GSK Study 222168) used administrative claims data supplemented with patient- and community-level measures of SDoH. Humana MA enrollees 18–89 years of age (YOA) with SLE (with or without LN) and enrolled during the 2023 calendar year were included. Diagnosis of SLE was required on ≥1 medical claim during 2023 and ≥1 diagnosis prior to 2023. Measures of disease burden, medication use, and HCRU were based on claims data. Measures of social risk (e.g. low-income subsidy [LIS], dual eligibility [DE], disability) were based on enrollment file data. Community-level measures of social risk (e.g. public assistance, educational attainment) were based on publicly available data sources. Analyses were descriptive.

Results: Among 20,188 patients with SLE identified (90.3% female, 30.7% of Black race), 76.2% had a Health Equity Index and 46.3% had a DE/LIS status. Approximately half of MA enrollees were < 65 YOA (45.5%). Compared with enrollees ≥65 YOA, < 65-year-olds had elevated social risk factors, with nearly all (99.7%) having disability and DE/LIS status (Table 1). MA enrollees < 65 YOA also tended to reside in communities with greater social risk (lower income and educational attainment, higher unemployment, greater use of public assistance; Table 1). Moderate/severe SLE was more common among enrollees < 65 YOA (82.8% vs 78.4%), who also had higher treatment rates with SLE medications compared with enrollees ≥65 YOA (Table 2).Disability as the original reason for MA qualification was common overall (67.7%), including 98.3% of < 65 YOA and 42.2% of ≥65 YOA enrollees (Table 1). Among enrollees ≥65 YOA who originally qualified for MA based on disability, social risk factors, disease severity, SLE medication use, and HCRU were generally greater than for the enrollees ≥65 YOA overall (Table 1 and 2). Enrollees < 65 YOA were more likely to visit a rheumatologist (36.5% vs 30.3% of those ≥65 YOA) or a nephrologist (7.2% vs 5.0% of those ≥65 YOA) for an SLE-related visit (Table 2). Among the enrollees < 65 YOA who visited a rheumatologist or nephrologist, 46.1%, 70.7%, and 14.2% received immunosuppressant, antimalarial, and biologic treatment, respectively.

Conclusion: We observed substantial social risk factors among MA enrollees with SLE, with disability being the dominant reason for MA qualification. SLE severity, treatment patterns, and HCRU varied between ≥65 and < 65-year-olds. Interventions to address the unmet needs should consider the burden of SDoH and diversity of the MA SLE population. Further research is needed to identify and evaluate specific health-related unmet needs of this population, potential interventions, and impact on patient outcomes.Funding: GSKReference1Lim SS et al. Arthritis Care Res 2025 (in press)

Table 1. Patient SDoH characteristics stratified by age and qualification for MA on the basis of disability.

*Enrollees ≥65 YOA who originally qualified for MA based on disability; †a higher ADI score is indicative of high levels of area deprivation and lower score is indicative of area affluence; ‡approximately 91% of patients were matched to the AHRQ SDoH database at census tract level, and the rest were matched at zip code level. There were 72 observations with missing value on median household income, 91 on percentage of families with children that are single-parent families. The rest of the AHRQ measures had 0–5 missing values; §percentage below national median; ǁpercentage above national median.

ADI, area deprivation index; AHRQ, Agency for Healthcare Research and Quality; CMS, Centers for Medicare and Medicaid Services; HEI, Health Equity Index; SD, standard deviation.

Table 2. Patient disease and treatment characteristics, and HCRU, stratified by age and qualification for MA on the basis of disability.

*Enrollees ≥65 YOA who originally qualified for MA based on disability; †PCP included family medicine, internal medicine, and general practice.

ED, emergency department; PCP, primary care provider.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-do-social-determinants-of-health-differ-across-age-and-disability-groups-among-adult-medicare-advantage-enrollees-with-systemic-lupus-erythematosus/