Background/Purpose: Black or African American women are disproportionately affected by SLE but remain underrepresented in research studies. To further knowledge about this health disparity group, the goal of this study is to thoroughly investigate the relationship between discrimination and SLE disease outcomes in Black women with SLE.

Methods: Adult Black women meeting either the 1997 ACR revised criteria or the SLICC criteria for SLE, or without any connective tissue disease, were recruited for the Social Factors, Epigenomics and Lupus in African American Women (SELA) study. SLE disease activity was measured using the Systemic Lupus Activity Questionnaire (SLAQ), and SLE organ damage was measured using the Brief Index of Lupus Damage (BILD). Racial discrimination was measured using the Experiences of Discrimination (EOD) questionnaire, a validated multi-item measure used to assess experiences of racial discrimination. A Welch two sample t-test was computed for the associations between EOD and SLAQ, and a Wilcoxon rank sum test with continuity correction was computed for EOD and BILD. A linear model was also computed to test for association between EOD and log-transformed BILD, controlling for age. All analyses were performed on RStudio v4.0.3.

Results: This study enrolled 209 self-identified Black females, including 121 with SLE. The mean (±SD) age of SLE participants was 45.9±11.7 years, and the mean age of controls was 48.2±12.9 years. Among those with SLE, disease duration at the study visit was 17.1±8.8 years. Participant reported organ damage score measured by the BILD was 2.43 on average. Although some sociodemographic and behavioral characteristics were similar in patients and controls (e.g., 30% were married, 86% rarely or never drank), many other characteristics differed between the groups. Of controls, 89% reported experiencing racial discrimination, compared to 81% of SLE participants. No significant association was found between racial discrimination and SLE activity or organ damage after adjusting for age.

Conclusion: This study conducted in participants from South Carolina found higher rates of personal experiences with racial discrimination than a national survey,¹ but similar to those reported in a previous study of Black women with SLE living in Atlanta, Georgia.² Unlike this previous report,² mean BILD score was significantly lower which may explain why the current study did not find associations between racial discrimination and SLE activity nor organ damage. Further investigation into environmental and socioeconomic differences between these communities that may affect SLE outcomes is warranted. Given the heterogeneity of Black communities, continued recruitment into this study and increased sample size is expected to enhance our knowledge about SLE in this population.

¹Pew Research Center. On Views of Race and Inequality, Blacks and Whites Are Worlds Apart. June 27, 2016.

²Chae et al. Racial Discrimination, Disease Activity, and Organ Damage: The Black Women’s Experiences Living With Lupus (BeWELL) Study. Am J Epidemiol. 2019;188:1434-1443.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-discrimination-among-african-american-women-with-and-without-systemic-lupus-erythematosus-sle/