‘The effects of racism’: Patients of color with lupus experience diagnostic delays
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People of color with lupus are more likely to experience delayed diagnosis along with greater rates of morbidity and mortality, compared with white patients, according to data.
The data were presented at The Future of Systemic Lupus Erythematosus Diagnosis and Treatment meeting, hosted by the University of Texas Southwestern Medical Center, in Dallas.
“Here is what we know: Lupus incidence and prevalence is higher in minority groups,” Ashira Blazer, MD, assistant attending physician and assistant professor of medicine at Weil Cornell Medical College, in New York, said in her presentation. “All non-white groups, including Black, Asian, Pacific Islander, Hispanic, Indian or Native Alaskan groups are more likely to suffer from lupus than other groups.”
In addition, these populations also are more likely to experience morbidity and mortality from the disease than white populations, according to Blazer.
It is important to note that people of all races are “99.9% the same” genetically, she added. “So, when we measure racial differences in medicine, we are largely measuring the effects of racism,” Blazer said.
One of the key impacts of structural and systemic racism is that patients from historically underrepresented groups commonly have less interaction with health care providers than their white counterparts, according to Blazer.
For example, in studying socioeconomic patterns as a function of health care engagement in New York, Blazer has observed that individuals from communities of color are more likely to receive care from community care centers as opposed to academic medical centers.
“Community care centers are less likely to screen for lupus,” she said.
Blazer then noted why this is important: “Early lupus diagnosis is associated with fewer flares,” she said.
Conversely, patients who are diagnosed more than 6 months after disease onset are more likely to experience higher rates of flares.
Flares are a signal of poorly controlled disease, which can, in turn, put patients at risk for complications across organ systems, including hypertension, renal disease and neurological outcomes.
“We have seen that these outcomes are worse in African American versus patients of European descent,” Blazer said. “This is really important because these are the harbingers of morbidity and mortality in lupus.”
Adverse infectious outcomes are also seen more commonly among patients from communities of color, a point which was highlighted by the COVID-19 pandemic.
“Among our lupus patients, people who tested positive for COVID were more likely to come from deprived areas [of New York],” Blazer said.
Although there are no easy solutions to these problems, Blazer suggested some ways to yield benefit. To start with, quantitative research is needed regarding the scope of racial disparities in lupus treatment. In addition, community partnerships, with education about the disease and its treatments as a key component, can increase the engagement of lupus populations from underrepresented communities with the health care system.
Lastly — but perhaps most importantly — diversifying the rheumatology workforce is critical, Blazer said.
“Reaching patients of all backgrounds requires a multi-layered approach,” she concluded.
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Blazer A. Socioeconomic Determinants in Lupus. Presented at The Future of Systemic Lupus Erythematosus Diagnosis and Treatment: A Discussion with the Experts; May. 7, 2022. (virtual meeting).
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