Estimating the Outcome Disparities in BIPOC and Economically-Disadvantages Patients With Systemic Lupus Erythematosus (SLE)

OBJECTIVES: SLE is a complex autoimmune disease with heterogeneous presentation and progression, posing significant treatment challenges. Despite medical advances, SLE's burden disproportionately affects the BIPOC population and individuals of lower socioeconomic status. This study aims to provide an understanding of SLE care disparities, examining mortality rates, treatment accessibility, and the impact of social determinants of health.

METHODS: Our study involved a literature search on PubMed, spanning from 2018 to 2023. We combined key terms related to SLE, Medicaid, health disparities, and treatment patterns, aiming to collate studies addressing treatment disparities in minority and economically-disadvantaged SLE patients in the U.S. There were exclusion criteria for age, region, and context.

RESULTS: After applying the exclusion criteria, the search resulted in 43 relevant studies. The prevalence of SLE was 195 per 100,000, with greater prevalence observed in the US South, African American population, and females. The literature found notable disparities in SLE mortality rates, with increased mortality in African American, Hispanic American, and low socioeconomic individuals. Hospitalization trends showed an increase in African American patient hospitalizations from 37.7% to 44.7% over two decades, alongside similar trends in Hispanic and Asian patients. A significant difference was noted in SLE disease duration, notably greater in African Americans (15 years) compared with non-Hispanic Whites (8 years). Socioeconomic factors were linked to a higher incidence of depression in SLE patients and higher medication nonadherence rates in these groups. In SLE patients, the literature showed an increase in risk of severe COVID-19 outcomes in African American (OR 2.73) and Hispanic (OR 2.76) SLE patients compared to White patients.

CONCLUSIONS: This study underscores significant health equity issues in SLE treatment, especially affecting BIPOC and low-income populations. Healthcare systems and policies must be restructured to provide equitable access and treatment, considering the social, economic, and cultural contexts of SLE patients.