title: Low socioeconomic status is associated with cardiovascular risk factors and outcomes in systemic lupus erythematosus.
abstract: OBJECTIVE
  Accelerated atherosclerosis is a major cause of death in systemic lupus erythematosus (SLE), yet little is known about the effect of socioeconomic status. We investigated whether education or income levels are associated with cardiovascular risk factors and outcomes in SLE.
  
  
  METHODS
  Our study involved a longitudinal cohort of all patients with SLE enrolled in the Hopkins Lupus Cohort from 1987 through September 2011. Socioeconomic status was measured by education level (≥ 12 years or < 12) and income tertiles (> $60,000, $25,000-$60,000, or < $25,000).
  
  
  RESULTS
  A total of 1752 patients with SLE were followed prospectively every 3 months. There were 1052 whites and 700 African Americans. Current smoking, obesity, hypertension, and diabetes mellitus were more common in African Americans (p < 0.01 for all), but there was no statistical difference in the frequency of myocardial infarction or stroke. In multivariate analyses stratified by ethnicity, low income was strongly associated with most traditional cardiovascular risk factors in whites, but only with smoking and diabetes in African Americans. In whites, low income increased the risk of both myocardial infarction (OR 3.24, 95% CI 1.41-7.45, p = 0.006) and stroke (OR 2.85, 95% CI 1.56-5.21, p = 0.001); in African Americans, these relationships were not seen. Low education, in contrast, was associated with smoking in both ethnic groups.
  
  
  CONCLUSIONS
  Low income, not low education, is the socioeconomic status variable associated with cardiovascular risk factors and events. This association is most clearly demonstrable in whites.
authors.affiliation: Johns Hopkins University School of Medicine, 1830 East Monument St., Suite 7500, Baltimore, MD 21205, USA.
authors.forename: Janet W
authors.initials: JW
authors.lastname: Maynard
authors.forename: Hong
authors.initials: H
authors.lastname: Fang
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000191:economics* / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity / Q000639:trends; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000191:economics* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012923:Social Class; D016896:Treatment Outcome; D055815:Young Adult