A More Equitable Future in Lupus Care & Outcomes

Dubois Memorial Lecture

WASHINGTON, D.C.—Where you live, what you look like, and how much money you make—to name a few—all affect health outcomes. And as physicians, we want the best for our patients. So what can we do to make a difference?

Dr. Feldman

Candace Feldman, MD, MPH, ScD, assistant professor of medicine, Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital and Harvard Medical School, Boston, has devoted her career to studying health inequities. At ACR Convergence 2024, she delivered the Dubois Memorial Lecture, Building a More Equitable Future in Lupus Care and Outcomes, where she passionately shared data on what is known, what has been tried and what else could be done moving forward to close the gap.

Health Inequities

Health inequities are “differences in health status, or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age,” Dr. Feldman said, and, most importantly, “Health inequities are unfair, preventable and modifiable.” The last two words serve as motivation for her research and talk.

Health inequities come from differences in 1) the receipt of high-quality care and preventive care; 2) access to sustained healthcare, medications and research; 3) life conditions (e.g., opportunities, exposures, stressors, support); and 4) health-related behaviors. They are driven by societal structures that have been perpetuated over time through policies and by institutions.

“True or false?” Dr. Feldman asked the audience. “The estimated number of deaths in the United States attributable to social determinants of health (e.g., education access and quality, neighborhood, economic stability, etc.) is comparable to the number attributed to pathophysiological and behavioral causes.” The answer? True.

Several studies demonstrate both racialized and socioeconomic inequities in systemic lupus erythematosus (SLE).^1,2 Black, American Indian/Alaska Native and Hispanic/Latinx individuals have a higher incidence and prevalence of SLE and lupus nephritis (LN). These minoritized populations also see poorer SLE-related outcomes (e.g., mortality, end-stage renal disease). Individuals residing in lower socioeconomic status areas have a higher prevalence of SLE, and poverty is associated with a higher burden of renal and cardiovascular disease, SLE-related damage and mortality.

Promising Interventions to Address Inequities

Dr. Feldman shared an overwhelming amount of data to illustrate the current state of health inequities in the United States that’s beyond the word count I was allotted for this assignment. And if I’m being frank, I felt depressed hearing it and wondered if inequities might actually be harder to treat than SLE itself. The upside? A lot of great minds—Dr. Feldman included—are designing interventions that might make a difference.