Poverty worsens lupus effects

WASHINGTON — Patients with lupus who were poor for more years showed more disease damage than patients who are poor for fewer years or were never poor, according to data presented at the American College of Rheumatology Annual Meeting, here.

“The purpose of the present study is to evaluate the effect of concurrent poverty, dose of poverty and exiting poverty on subsequent accumulation in damage of lupus,” Edward H. Yelin, PhD, in the divisions of Medicine and Rheumatology at the University of California at San Francisco (UCSF), said in his presentation.

As part of the UCSF Lupus Outcomes Study, Yelin and colleagues studied patients from 2003 to 2015 through annual surveys, in which they used household income and family size to determine poverty status. The researchers reviewed medical records to confirm lupus diagnosis. Starting in 2009, the survey included the Brief Index of Lupus Damage, for which 783 patients responded.

Of the responders, 94% were female, 35% non-white and 15% in poverty. Mean age was 49.8 years and mean lupus duration was 16.9 years. Yelin and colleagues estimated the percentage of years spent in poverty between 2003 and 2009, the impact of poverty in 2009 and the effect leaving poverty in 2009 had on damage accrued between 2009 and 2015. The researchers adjusted for demographics, education, lupus duration, health care characteristics and health behavior.

Patients who were poor in 2009 scored higher in lupus damage compared to patients who were not poor (1.97 vs. 1.34). Patients who were poor for all the years between 2003 and 2009 had more disease damage than patients who were poor for only some years (2.45 vs. 1.45 and 1.49 for at least 50% and less than 50% of years, respectively) and compared with patients who were never poor (2.45 vs. 1.34). Additionally, patients who were poor in 2015 showed more lupus damage than patients who left poverty in 2014, as well as patients who left between 2012 and 2013, 2004 and 2010 and those who never left poverty.

“Beyond improving access to high quality care, reducing damage in lupus may require efforts to reduce the stresses associated with poverty, for example, by advocating for increased level of economic assistance and social services,” Yelin said. – by Will Offit

Reference:

Yelin EH, et al. Abstract #1958. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.

Disclosure: The researchers report no relevant financial disclosures.