The role of neighborhood and individual socioeconomic status in outcomes of systemic lupus erythematosus.
OBJECTIVE
To determine if neighborhood socioeconomic status (SES) is independently related to physical and mental health outcomes in systemic lupus erythematosus (SLE).


METHODS
Data derived from the first 3 waves of the Lupus Outcomes Study, a telephone survey of 957 patients with confirmed SLE diagnoses, recruited from clinical and non-clinical sources. Residential addresses were geocoded to U.S. Census block groups. Outcome measures included the Systemic Lupus Activity Questionnaire (SLAQ) score, a self-reported assessment of SLE symptoms; the Medical Outcomes Study Short Form-36 Health Survey physical functioning score; and Center for Epidemiologic Studies-Depression (CES-D) score of > or = 19 points. Multivariate analyses adjusted for race/ethnicity and other demographic and health-related covariates.


RESULTS
After adjustment, lower individual SES, measured by education, household income, or poverty status, was associated with all outcomes. In models that did not include individual SES, low neighborhood SES (> 30% of residents in poverty) was also associated with poor outcomes. After adjustment for individual SES, demographic, and health-related covariates, only CES-D > or = 19 remained associated with neighborhood SES: 47% [95% confidence interval (CI) 38-56%] versus 35% (95% CI 32-37%).


CONCLUSIONS
Individual SES is associated with physical and mental health outcomes in persons with SLE. Low neighborhood SES contributes independently to high levels of depressive symptoms. Future research should focus on mechanisms underlying these differences.
Trupin
Laura
L
Department of Medicine, Institute for Health Policy Studies, University of California, San Francisco, CA 94143-0920, USA. laura.trupin@ucsf.edu
Tonner
M Christine
MC
Yazdany
Jinoos
J
Julian
Laura J
LJ
Criswell
Lindsey A
LA
Katz
Patricia P
PP
Yelin
Edward
E
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology* / Q000473:pathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult