Background/Purpose: The association between socioeconomic status and damage in Systemic lupus erythematosus patients is confounded by the influence of race in various previous studies.  The objective of the study was to evaluate the association between socioeconomic status and Quality of life and damage in SLE patients.

Methods: SLE patients (ACR criteria),  age ≥ 18 y.o. with at least 12 months of diagnosis were included. Socioeconomic status was evaluated by monthly income and years of formal education. The race was self-reported as white and nonwhite. The study was approved by Institutional Ethic Committee. Assessments were performed by questionnaire and review of medical charters; Mex-SLEDAI score; SF-36 and SLEQOL questionnaire. Statistical analysis: descriptive analysis, median, mean, t-student; Mann-Whitney, chi square, ROC curve  to establish cut-off, Pearson and Spearman correlation test, univariate and multivariate regression test were used. P<0.05 was considered significant.  

Results: 523 patients ( 96% female / 51.2% nonwhite) with mean age of 37,8±11,4 years were included. The mean years of study were 10.2±3.5.  63,7%; of patients did not  work. The mean SLEDAI score was 1,82±2,83 and the per capita income was US$ 402.7± 610.95 and the family income was US$  1,147.62 ± 1,713.40. Arthritis, photosensivity, hematological involvement and AAN positivity were the most frequent ACR criteria. Hypertension, fibromyalgia, and hypothyroidism were the most frequent comorbidities. Corticosteroids and antimalarials were most common treatment. The median prednisone dose was 15mg/day. Patients with income  > US$ 402.7  used lower prednisone/day (P= 0,029 and more frequently antimalarial (P= 0,002). Persistent proteinuria and  clearance < 50 ml/min were the most  frequent damage. The mean  SLICC/ACR ID was  1,4±1,52. Patients with  SLICC > 0  had lower income (p= 0,039) and nonwhite patients had SLICC higher than white one  (P= 0,005). The SLICC was correlated with disease duration (P < 0,001) and  with patient age (P< 0,001), and negatively correlated  with years of formal education (P = 0,001). Patients who were working had SLICC lower than those were not working  (P <0,001).  Univariate analysis showed that those with income < US$ 402.7 have  1,6 time more likely to have SLICC > 0 (P= 0,009); nonwhite patients have 1,6 times more likely to have SLICC > 0 (P= 0,009) and each additional year of study decreases by 91% the chance to have SLICC > 0. Multivariate analysis showed that race (P=0.044) and years of study were the best predictors of damage (P= 0,033). The lowest scores of the SF-36 were physical, emotional and mental domain. The SLICC correlated significantly with functional capacity; physical aspect ; emotional aspect and physical domain. The SLICC score correlated significantly with SLEQOL total score, physical function, occupational activity and treatment.

Conclusion: Disease duration, age of the patients and mainly race and socioeconomic status are important factors that influence the onset of damage. The damage interferes with the quality of life, especially the physical domain of patients with SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-influence-of-socioeconomic-and-race-in-damage-score-in-patients-with-systemic-lupus-erythematosus/