title: Disease features and outcomes in United States lupus patients of Hispanic origin and their Mestizo counterparts in Latin America: a commentary.
abstract: OBJECTIVE
  To evaluate disease features and outcomes in two populations with significant Amerindian ancestry.
  
  
  METHODS
  Hispanic patients (from Texas) from the Lupus in Minorities: Nature versus Nurture (LUMINA) cohort and Mestizo patients from the Grupo Latino Americano De Estudio del Lupus or Latin American Group for the Study of Lupus (GLADEL) cohort were included. Disease features and outcomes were evaluated at baseline and last visit. Admixture informative markers of Mestizo Genoma de Lupus Eritematoso Sistémico Network consortium (GENLES) patients and Hispanic LUMINA patients were compared. Univariable analyses were performed using Chi square or Student's t test as appropriate. Multivariable analyses adjusting for possible confounders were carried out using Poisson, logistic or Cox regression models as appropriate.
  
  
  RESULTS
  A total of 114 LUMINA and 619 GLADEL patients were included. GLADEL patients had accrued more damage at baseline, but the opposite was the case at last visit. Being from LUMINA was a risk factor for damage accrual, even after adjusting for possible confounders [relative risk (RR) 1.33, 95% CI 1.12, 1.58]. Also, LUMINA patients have a higher risk of mortality than GLADEL patients [hazard ratio (HR) 2.37, 95% CI 1.10, 5.15], having 5-year survival of 85.6% and 94.5%, respectively. In addition, 79 LUMINA patients and 744 Mestizo GENLES patients were evaluated in order to compare genetic ancestry between the two groups; GENLES patients had a higher proportion of European ancestry (48.5% vs 43.3%, P = 0.003) and a lower proportion of Asian ancestry (3.7% vs 4.9%, P = 0.048), but the proportions of Amerindian and African ancestry were comparable in both.
  
  
  CONCLUSIONS
  USA Hispanic patients seemed to have a poorer prognosis than their counterparts from Latin America, despite having a comparable genetic background. Socioeconomic factors may account for these observations.
authors.affiliation: Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Universidad Científica del Sur, Lima, Perú, manuel_ugarte@yahoo.com.
authors.forename: Manuel F
authors.initials: MF
authors.lastname: Ugarte-Gil
authors.affiliation: Department of Autoimmune Diseases, Institut Clinic de Medicina I Dermatologia, Hospital Clinic, Barcelona, Catalonia, Spain.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Pons-Estel
authors.affiliation: Arthritis and Clinical Immunology Department, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: Molineros
authors.affiliation: Departamento de Estadística, Universidad Nacional de Rosario, Rosario, Argentina.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wojdyla
authors.affiliation: Department of Epidemiology, Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.affiliation: Arthritis and Clinical Immunology Department, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
authors.forename: Swapan K
authors.initials: SK
authors.lastname: Nath
authors.affiliation: Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina.
authors.forename: Bernardo A
authors.initials: BA
authors.lastname: Pons-Estel
authors.affiliation: Arthritis and Clinical Immunology Department, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA, Centro de Genómica e Investigación Oncológica Pfizer-Universidad de Granada-Junta de Andalucía, Granada, Spain and.
authors.forename: Marta
authors.initials: M
authors.lastname: Alarcón-Riquelme
authors.affiliation: Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Graciela S
authors.initials: GS
authors.lastname: Alarcón
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D020022:Genetic Predisposition to Disease / Q000208:ethnology*; D006630:Hispanic or Latino / Q000208:ethnology / Q000235:genetics*; D006801:Humans; D007843:Latin America; D008180:Lupus Erythematosus, Systemic / Q000208:ethnology* / Q000235:genetics* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D016012:Poisson Distribution; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D014481:United States; D055815:Young Adult
keywords: ethnic group; genetic predisposition to disease; outcome; systemic lupus erythematosus