In two new retrospective studies, investigators have found that social determinants of health may be contributing factors in disease prevalence and severity among Black and Hispanic pediatric patients with systemic lupus erythematosus, according to a report from Medscape.
In the first study—presented by Beil et al at the American College of Rheumatology’s (ACR) 2023 Pediatric Rheumatology Symposium—the investigators analyzed the cases of 136 pediatric patients with lupus for factors such as race/ethnicity, primary language, insurance status, referral source, primary care physician availability, and transportation requirements—all of which had the potential to impact lupus prevalence and severity. They discovered that Black pediatric patients and those who were uninsured scored higher on the Systemic Lupus Erythematosus Disease Activity Index and had a greater likelihood of having central nervous system involvement compared with non-Hispanic White patients. Further, compared with 12% of those insured by Medicaid and 7% of those who were privately insured, over 50% of patients without insurance did not have access to primary care physicians.
In the second study—presented by Dhanrajani et al at the ACR’s 2023 Pediatric Rheumatology Symposium—investigators identified the demographics as well as socioeconomic and clinical characteristics of 36 pediatric patients with lupus and found that 78% of the patients identified as Black and 83% of them resided in areas with medium-high to high Social Vulnerability Index scores. Additionally, they found that compared with averages from other studies, the median distance the patients were required to travel for standard care was 75 miles vs 43 miles, and the median Systemic Lupus Erythematosus Disease Activity Index scores were 12.1 vs 3.1. The investigators concluded that many of these risk factors may be modifiable, and that various measures—such as greater inclusion of patients in the decision-making process, better communication to patients about their social determinants of health, and improved resources and social outreach at the community level—need to be taken to reduce health disparities for pediatric patients with lupus.