Session Information
Date: Monday, November 9, 2015
Title: ARHP II: Lupus
Session Type: ARHP Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Health perceptions, such as self-rated health, have been shown to predict multiple adverse health outcomes and to have a strong socioeconomic status (SES) gradient. Although SES-related health disparities have been found in lupus, previous studies have not examined the role of SES in health perceptions in lupus, independent of other health factors.
Methods: Data were from the National Data Bank for Rheumatic Diseases (NDB), for which participants complete questionnaires every 6 months. We included in analyses only women with lupus who responded to at least one questionnaire in 2014 (n = 481). Health perceptions were measured with 3 items: (1) health status numeric rating scale ranging from 0 (dead) to 100 (perfect health); (2) health satisfaction (“how satisfied are you with your health?”); responses ranged from very unsatisfied to very satisfied; and (3) overall health rating (excellent, good, fair, poor). The latter two items were dichotomized for analysis (satisfied or very satisfied vs. other; excellent or good vs. fair or poor). Potential predictors of health perceptions included SES (age, education, Medicaid or no health insurance vs other), lupus status (duration, disease activity measured with the Systemic Lupus Activity Questionnaire [SLAQ]), disease damage measured with the Brief Inventory of Lupus Damage [BILD]), and symptoms and other health factors (obesity, pain, physical function, fatigue, comorbidities, depressive symptoms, sleep, and smoking). Multiple linear and logistic regression analyses were conducted to identify independent predictors of health perceptions.
Results: Sample characteristics are shown in Table 1. In models including only age and SES variables, only low education was associated with health perceptions (Table 2). After adding lupus status, symptoms, and other health factors, SES variables were no longer associated with health perceptions. Four variables were consistently associated with each health rating: pain rating, physical function, disease activity, and smoking.
Conclusion: Health perceptions in lupus were primarily driven by health-related variables rather than SES. It is possible, however, that the effects of SES may be indirect; for example, smoking rates are higher among individuals with lower education. Additional study is needed to identify the ability of health perceptions s to predict health outcomes in lupus.
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Table 1. Characteristics of sample |
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SES variables |
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Age, mean ± SD |
57.9 ± 13.0 |
Education ≤ 12 years |
22.1% |
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White
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79.4% |
Medicaid or no health insurance |
13.5% |
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Lupus status |
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Duration |
21.0 ± 12.1 |
Disease damage (BILD) |
3.3 ± 2.0 |
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Disease activity (SLAQ)
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11.0 ± 7.1 |
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Symptoms, other health factors |
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Pain rating1 |
4.3 ± 3.0 |
Rheumatic Disease Comorbidity Index5 |
2.7 ± 1.8 |
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Physical function2 |
38.4 ± 27.7 |
Obesity |
33.6% |
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Fatigue3 |
5.2 ± 3.1 |
Depressive symptoms6 |
5.9 ± 5.4 |
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Sleep4
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4.4 ± 3.2 |
Smoking (current and past) |
42.6% |
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Health perceptions |
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Health status rating7 |
63.5 ± 20.9 |
Satisfied, very satisfied with health |
44.8% |
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Excellent, good health |
46.4% |
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1 Pain: 1-10 rating, higher rating = greater pain. 2 Physical function: SF-36 Physical Function subscale, range 0 – 100, higher score = better function. 3 Fatigue: 1-10 rating, higher rating = greater fatigue. 4 Sleep: 0-10 rating of problematic sleep, higher rating = more sleep problems. 5 Rheumatic Disease Comorbidity Index: Validated index that encompasses 11 comorbid illnesses (England BR, et al. Arthritis Care Res2015; 6: 865). Score ranges from 0-9. 6 Depressive symptoms: from PHQ-8, higher score = more depressive symptoms. 7 Rating of health state from 0 (dead) – 100 (perfect health) |
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Table 2. Regression results: Independent predictors of health perceptions* |
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Significant associations |
Health rating VAS§ |
Satisfied with health† |
Excellent/good health† |
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Model 1: SES variables only |
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Low education |
-5.22 (0.10) |
0.49 (0.30, 0.79) |
0.52 (0.32, 0.87) |
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Model 2: SES + lupus status, symptoms, other health factors |
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Low education |
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0.45 (0.19, 1.07) |
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Pain rating |
-1.32 (.02) |
0.79 (0.67, 0.93) |
0.82 (0.69, 0.99) |
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Physical function |
0.23 (<.0001) |
1.02 (1.01, 1.04) |
1.05 (1.03, 1.07) |
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SLAQ |
-0.44 (.04) |
0.90 (0.83, 0.97) |
0.89 (0.82, 0.97) |
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Smoking (current or former) |
-3.84 (.07) |
0.46 (0.23, 0.95) |
0.29 (0.13, 0.65) |
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Comorbidity index |
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0.78 (0.61, 0.99) |
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BILD |
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1.22 (0.99, 1.51) |
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* Table includes only predictors significant at p≤0.10. § Tabled values are beta (p-value) from multiple linear regression analysis † Tabled values are odds ratio(95% confidence interval from multiple logistics regression analysis. |
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To cite this abstract in AMA style:
Katz PP, Chakravarty E, Katz RS, Michaud K. Predictors of Health Perceptions Among Women with Lupus [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/predictors-of-health-perceptions-among-women-with-lupus/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-health-perceptions-among-women-with-lupus/