A multiethnic, multicenter cohort of patients with systemic lupus erythematosus (SLE) as a model for the study of ethnic disparities in SLE.
OBJECTIVE
To examine health disparities as a function of ethnicity using data from LUpus in MInorities, NAture versus nurture (LUMINA), a longitudinal study of patients with systemic lupus erythematosus (SLE); to build an explanatory model of how ethnic disparities occur in this setting; and to suggest appropriate interventions.


METHODS
LUMINA patients (meeting American College of Rheumatology criteria for SLE) ages >/=16 years of African American, Hispanic (from Texas), Hispanic (from Puerto Rico), or Caucasian ethnicity were studied. In addition to examining the basic features of the cohort, we examined, by univariable and multivariable analyses, the factors associated with disease activity, damage accrual, lupus nephritis, and mortality. An empiric model based on the data presented (and the literature reviewed) was derived to explain the disparities observed.


RESULTS
There were substantial differences in the socioeconomic/demographic, clinical, and genetic features among patients from the different ethnic groups, with Texan Hispanic and African American patients exhibiting overall a lower socioeconomic status, different genetic associations, more serious disease at a younger age, and worse intermediate and final outcomes than the Caucasian and Puerto Rican Hispanic patients. A model of disease outcome as a function of the disparities observed was created.


CONCLUSIONS
Ethnic disparities occur in SLE. Environmental, socioeconomic/demographic, psychosocial, genetic, and clinical factors play an important role as determinants of the ethnic differences observed. Measures aimed at eliminating these disparities are suggested while further research is conducted to elucidate the basis of these disparities and their changes at the societal level and to eliminate the gap between the rich and the poor.
Fernández
Mónica
M
The University of Alabama at Birmingham, AL, USA.
Alarcón
Graciela S
GS
Calvo-Alén
Jaime
J
Andrade
Rosa
R
McGwin
Gerald
G
Vilá
Luis M
LM
Reveille
John D
JD
D000328:Adult; D001741:Black or African American / Q000235:genetics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006683:HLA-DQ Antigens / Q000235:genetics; D006684:HLA-DR Antigens / Q000235:genetics; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000235:genetics / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000208:ethnology* / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D008181:Lupus Nephritis / Q000208:ethnology / Q000235:genetics / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012219:Rheumatology / Q000706:statistics & numerical data*; D012923:Social Class; D013781:Texas / Q000453:epidemiology; D044465:White People / Q000235:genetics / Q000706:statistics & numerical data
D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens