New Studies Examine Impact of Poverty, Race, Ethnicity in Patients with SLE

“In studies of social determinants of health, we often hear the saying that ‘poverty gets under the skin.’ We wanted to know what these mechanisms are that translate into having a poverty-level income that, in turn, means an increased risk for lupus damage.”

“This work revealed that the daily experience of chronic stress—food, housing and medical care insecurity—is a strong determinant of the extent of lupus-related damage. The mechanism is likely that when you are living with this type of chronic stress, securing food and housing takes precedence, and thus, people relegate dealing with their SLE [systemic lupus erythematosus] to the back burner, except when a flare demands their immediate attention.”

Personal Problems Are Also Societal

Dr. Salmon

At the end of their study, Dr. Yelin and his colleagues conducted qualitative interviews that focused on what stressors the patients found to be particularly debilitating. “We found that exposure to crime or fear of crime in their neighborhoods stood out as an important factor. A picture is emerging that shows us that it takes far more than great medical care to get good results for lupus patients. It raises the hard questions of what the proper role of healthcare providers is. We cannot ask [healthcare providers] to deal with these powerful societal forces that have kept people in poverty for multiple generations.”

And yet the answer is not to turn away from the problem. “There are many physicians who practice in the public health system who deal with these issues on a daily basis. In addition, as a society, we must turn our attention to the intersection between health and housing. Our quantitative data showed those who exited poverty were able to get back on track to a certain extent with regard to their disease. We need to examine the question of whether people with the disease should be aided in the attempt to move out of poor neighborhoods.”

Physicians want to do medicine. But as in anatomy with, for example, hip and spine pain being interrelated, lupus is related to its environment. Doctors and patients will lag behind in outcomes as long as such peripheral issues are left unaddressed.

Dr. Yelin says, “It is now clear that even in autoimmune diseases in people with profound genetic predispositions, we cannot ignore patients’ social environments.” Doing so can even encumber the lives of the next generation.

Pregnancy & Lupus

Jane Salmon, MD, is professor of medicine and professor of obstetrics and gynecology at Weill Cornell College of Medicine and the Collette Kean Research Professor at Hospital for Special Surgery in New York. Her recent work, published in Arthritis Care & Research, has uncovered evidence that black and Hispanic patients with lupus are more likely to experience pregnancy complications than are white women with the disease.²