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Blacks with lupus have higher comorbidity burden than whites
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Black patients with systemic lupus erythematosus demonstrated an increased comorbidity burden in every organ system compared with both whites with lupus and healthy blacks, according to findings published in Arthritis Research & Therapy.
“Our study is important because it uses a novel electronic health record (EHR)-based technique called phenome-wide association study (PheWAS) to examine racial disparities in systemic lupus erythematosus (SLE),” April Barnado, MD, MSCI, of Vanderbilt University Medical Center, told Healio Rheumatology. “PheWAS scan across billing codes in the electronic health record (EHR) similar to a GWAS scans across the genome. PheWAS have uncovered novel genetic associations in autoimmune diseases and been validated in follow-up studies.”
To determine the differences in comorbidities among black and white patients with SLE, the researchers drew data from a de-identified version of the electronic health records (EHR) at Vanderbilt University Medical Center, which includes 2.8 million individuals and corresponding longitudinal information collected during the past 7 decades. The researchers identified 270 blacks and 715 whites with SLE, as well as 1,424 matched black control patients who did not have the disease.
Data in the de-identified EHR included diagnostic and procedure codes, demographics, inpatient and outpatient notes, laboratory values, radiology and pathology results, and medication orders. The researchers performed phenome-wide association studies to compare cases among the three groups of patients, controlling for age, sex and race. In addition, the researchers used a false discovery rate (FDR) P value of .05 for multiple testing.
According to Barnado and colleagues, black patients with SLE had more comorbidities in every organ system compared with white patients with SLE, with the most prominent examples being hypertension (OR = 4.25; FDR P = 5.49 × 1015), renal dialysis (OR = 10.9; FDR P = 8.75 × 1014) and pneumonia (OR = 3.57; FDR P = 2.32 × 108). Black patients with SLE were also more likely to have comorbidities in every organ system when compared with blacks in the control group. The most significant comorbidities included renal failure (OR = 9.55; FDR P = 2.26 × 1040) and hypertensive heart and renal disease (OR = 8.08; FDR P = 1.78 × 1022).
After adjusting for race, age and sex, and including patients in all three groups, SLE was independently associated with renal, cardiovascular and infectious diseases (P < .01).
“These findings have important clinical implications that African Americans with SLE have a high burden of comorbid diseases and need not only timely rheumatologic care but also primary and specialist care,” Barnado said. “Our findings build upon cohort and administrative studies by focusing on African American SLE subjects and capturing both inpatient and outpatient diagnoses over decades of follow-up. PheWAS provide a robust approach to scan the entire EHR and systematically evaluate longitudinal data.” – by Jason Laday
Disclosure: Barnado reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Vickie L. Sayles, BSN, CRNI, RN-BC
In their recent study, Barnado and colleagues examined health disparities between African-Americans and Caucasians with SLE, utilizing EHRs rather than traditional cohort and administrative database studies.
EHRs integrate a wide variety of health information and are highly beneficial in obtaining information needed to study specific patient populations. The rapid growth in the use of EHR technology can assist researchers in monitoring and addressing health disparities and improve the coordination of care for SLE patients. Additionally, EHRs allow researchers to access structured and unstructured data on large, diverse, and geographically-distributed patient populations, making them valuable to investigators.
As observed in this study, examining the SLE population using an EHR system was beneficial to assess common comorbidities and racial disparities within this patient population. Determining the best course of action for the spectrum of disease manifestations in the SLE patient can ensure proper management and prevent further complications related to this disease.
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