Background/Purpose:  Ethnic differences in SLE are well known, but little is known about SLE in patients who have immigrated to North America from elsewhere in the world. Increasing rates of migration of individuals at high risk for SLE to Canada raise the potential for increased SLE specific healthcare needs. We aimed to describe immigrant patients within the 1000 Canadian Faces of Lupus Study.

Methods:  The 1000 Faces of Lupus cohort is a multi-centre Canadian cohort of >2000 incident and prevalent SLE patients. Sociodemographic variables, ACR classification criteria, SLEDAI scores, SLICC/ACR damage index (SDI) scores, and treatment history are collected using standardized tools. Ethnicity was self-reported. Cross-sectional baseline analyses included t tests and logistic regression.

Results:  1243/ 2048 patients provided information on country of birth and were included. Immigrants made up 20% of participants (254/1243), similar to the percent (20.6%) in the general Canadian population. Immigrants arrived in Canada at a mean age of 16±10 years, and had been in Canada an average of 16±14 years at time of SLE diagnosis. Among immigrants, only 32% were Caucasian versus 73% of the Canadian born patients; OR 0.2, 95%CI 0.13-0.23); while 35% of immigrants were Asian versus 13% of Canadian-born patients; OR 3.5, 95%CI 2.6-4.9). Disease duration (10 vs 9 years) and age at diagnosis (31 vs. 28 years) were similar across groups, but 32% of Canadian-born had disease onset in childhood versus 25% of immigrants; OR 1.5 95%CI 1.0-2.1). Mean ACR criteria (5.3 vs. 5.2) were similar, but immigrants were more likely to have lupus nephritis (42% vs. 27%; OR 2.0, 95% CI 1.5-2.7). Exposure to lupus drugs and self-reported access to care were similar between groups. SLEDAI scores were similar between the groups, but patient-reported disease activity scores (SLAQ) were significantly lower in immigrants (8.5 vs 10.7, mean difference (MD) -2.2; 95%CI -3.0- -1.4), while damage was higher in immigrants (SDI scores 1.4 vs 1.0; MD 0.4, 95%CI 0.1-0.6). Immigrants had higher physical health-associated quality of life (PCS) (41 vs. 37; MD 3.7, 95%CI 0.4-6.9) but mental health-associated quality of life (MCS) was similar. Comparing immigrant Asians (N=86) to Canadian born Asians (N=118); disease duration was similar, but immigrants were older at diagnosis (25 vs. 15 years), with only 20% having childhood-onset versus 58% of Canadian-born, OR 0.2, 95% CI 0.1-0.3. Number of ACR criteria, frequency of nephritis (50 vs 52%), medications, SLEDAI and SLAQ scores were similar. Immigrant and Canadian-born Asians had similar PCS and MCS scores and self-reported access to care, but immigrants had lower incomes (32% vs 17% low income, OR 2.2, 95% CI 1.1-4.6). SDI scores were higher in immigrants (0.9 vs 0.5; MD 0.4, 95%CI 0.04-0.80).

Conclusion:  Our data suggest relatively severe disease with high frequencies of nephritis and damage in immigrant SLE patients. The low proportion of immigrants with childhood onset SLE also suggests barriers to immigration in children with SLE. Statistics Canada predicts that the proportion of immigrants will increase by 50%by 2031; monitoring information about the characteristics of lupus in immigrants is timely and relevant.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-lupus-erythematosus-in-immigrants-results-from-the-1000-canadian-faces-of-lupus-study/