Addressing economic insecurities ‘could improve’ patient reported outcomes in lupus
Click Here to Manage Email Alerts
WASHINGTON — Addressing economic insecurities through a social worker “could improve” physical function and other patient reported outcomes in systemic lupus erythematosus, according to a speaker at ACR Convergence 2024.
“Key social determinants of health that drive poor patient reported outcomes (PROs) are not fully elucidated,” Shivani Garg, MD, assistant professor of medicine in the rheumatology division at the University of Wisconsin School of Medicine & Public Health, told Healio.
“Our group noted a complex interaction between biologic factors and social determinants of health that could drive disparities in SLE outcomes in the United States,” she added. “Our recent meta-analysis highlighted disparities in clinical outcomes for individuals with adverse social determinants of health.”
To identify key adverse social determinants of health, including economic insecurities, associated with poor PROs in SLE, as well as the impact of addressing these economic insecurities, Garg and colleagues examined data from the Wisconsin Lupus Cohort. Specifically, the researchers included adults with SLE recruited between 2020 and 2024.
Economic insecurities — including food, housing, transportation and financial issues — were assessed by a medical assistant with screening questionnaires. These were then addressed by a social worker.
Area deprivation index, insurance status, unemployment, high-risk behaviors and loneliness — classified as conventional social determinants of health — were also assessed.
The researchers gathered Patient-reported Physical, Mental, and Social Function T scores via the PROMIS global health short form. Meanwhile, any links between economic insecurities and PROs were determined through multivariable linear regression models, adjusting for demographics, SLE disease activity index (SLEDAI), SLE damage index (SDI), medicines, hydroxychloroquine doses, disease duration and conventional social determinants of health. The researchers also used a paired t-test to longitudinally compare PROs before and after economic insecurities were addressed.
The analysis included 217 patients, of whom 18% had at least one economic insecurity.
According to the researchers, every 1-unit increase in economic insecurity yielded decreases in outcomes, including a 2.5-point decrease in physical function (P = .02), a 0.33-point decrease in social function (P = .02) and a 2-point decrease in mental function (P = .09). Moreover, worse PROs were reported among patients who were unemployed or used Medicaid insurance.
“Adverse social factors in different domains drive a multiplicative negative impact on PROs,” Garg said. “PRO scores were two times lower in patients with one or more economic insecurity and Medicaid insurance, compared to those with no economic insecurities but with Medicaid insurance.
“A sequential increase in economic insecurities is linked with an additive negative impact on PROs,” she added. “We observed three to five times lower PRO scores with every 1-unit increase in economic insecurities versus those without any economic insecurities.”
Further findings demonstrated that among 36 patients with at least one economic insecurity, 21 completed a follow-up visit within 6 months. Social workers aided in addressing economic insecurities in 58% of the cohort. In those patients, physical function score improved by 7 points (P = .039), according to the researchers.
“Economic insecurities can be addressed with social worker’s support or by leveraging community resources, such as ride share, medication copay, financial assistance, childcare support and housing shelters,” Garg said.
However, social workers are not the only experts who can improve outcomes in patients with lupus who face economic insecurities.
“Screening for economic insecurities using existing tools in the EHR could help clinicians understand the full clinical picture and provide a holistic care to patients with a patient-centered approach,” Gard said. “Addressing economic insecurities could improve PROs and reduce disparities in lupus.”
Collapse
Garg S. Abstract #2555. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
Read more about
Click Here to Manage Email Alerts