Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic multisystemic immune-mediated disease with often nonspecific symptoms, associated with recurrent flares that can be life threatening. Prevalence of SLE in women and minorities especially African Americans (AA) are higher with a higher disease severity index ⁽¹⁾. Studies have shown that higher morbidity scores correlate with lower perceived physical health score ⁽²⁾. Our study aims to assess racial disparities in perception of health using morbidity index scores and perceived physical health in SLE patients.

Methods: We included 258,188 patients from All of Us dataset 6 from May 6, 2018 to January 1, 2022 who had available electronic health records data. SLE patients were identified with ICD 9/10 codes. We calculated average Charlson Comorbidity Index (CCI) for SLE patients and prevalence of the following common comorbidities by race: chronic pulmonary disease (CPD), peripheral vascular disease (PVD), renal disease (RD), diabetes (DM), and congestive heart failure (CHF). From the survey data, we calculated average PROMIS-PH scores to assess the degree of self-reported physical health, with responses ranging from 2 to 10. Analysis was performed in the web-based platform Jupyter Notebook using the programming language R.

Results: Of 4,959 patients with SLE, Whites (N=1,430) had the highest average CCI of 5.44, followed by 5.34 in AA (N=857) and 4.55 in Asians (N=85). AA showed the lowest average PROMIS-PH score of 5.82, representing worse perception of physical health, compared to Whites (6.32) and Asians (6.45). Asians had the lowest prevalence of CPD (30.6%) compared to AA (45.3%) and Whites (46.8%). PVD prevalence was similar in Asians (24.6%) and in AA (25.6%) but higher in Whites (29.8%). Of note, RD in Whites was the lowest with 23.9%, higher in AA (34.2%) and Asians (40%). For DM, AA had the highest prevalence at 37.1%, followed by 20.7% in Whites and 20% in Asians. Prevalence of CHF was notably high in AA (25.9%), 15.1% in Whites and less than 15% in Asians.

Conclusion: Despite similarity in average CCI between AA and White SLE patients, self-perception of physical health was significantly lower in AA. Our study shows that morbidity indices do not always correlate with perception of health. Differences in the types of comorbidities, such as CHF and DM in African Americans could be responsible for the disparities in perceived health.

References 1.Izmirly PM, Parton H, Wang L, McCune WJ, Lim SS, Drenkard C, Ferucci ED, Dall’Era M, Gordon C, Helmick CG, Somers EC. Prevalence of Systemic Lupus Erythematosus in the United States: Estimates From a Meta-Analysis of the Centers for Disease Control and Prevention National Lupus Registries. Arthritis Rheumatol. 2021 Jun;73(6):991-996. doi: 10.1002/art.41632. Epub 2021 Apr 23. PMID: 33474834; PMCID: PMC8169527.
2.Pak SS, Miller MJ, Cheuy VA. Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study. J Patient Rep Outcomes. 2021 Sep 6;5(1):81. doi: 10.1186/s41687-021-00360-8. PMID: 34487270; PMCID: PMC8421489.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-disparities-in-comorbidities-and-perception-of-physical-health-in-systemic-lupus-erythematosus/