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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
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Relationship Between Poverty and Mortality in Systemic Lupus Erythematosus
Edward Yelin1, Jinoos Yazdany2, Laura Trupin1
1Philip R. Lee Institute for Health Policy Studies and Rosalind Russell/Ephraim Engleman Rheumatology Research Center, University of California, San Francisco.
Arthritis Care & Research
|October 4, 2017
Summary
Poverty increases mortality risk in systemic lupus erythematosus (SLE) primarily by worsening disease damage. Accounting for this damage eliminates poverty
Area of Science:
- Rheumatology
- Public Health
- Health Disparities
Background:
- Prior research linked poverty to increased damage accumulation in systemic lupus erythematosus (SLE).
- Concurrent poverty, persistent poverty, and exiting poverty were previously associated with SLE damage progression.
Purpose of the Study:
- To investigate if concurrent poverty impacts mortality in SLE patients.
- To determine if disease damage accumulation mediates the relationship between poverty and mortality in SLE.
Main Methods:
- Analysis of 807 SLE patients from the University of California-San Francisco Lupus Outcomes Study (2009).
- Stratification based on household income relative to the federal poverty level.
- Cox proportional hazards regression used to assess mortality risk, adjusting for demographics, lupus status, damage extent, health status, behaviors, and healthcare characteristics.
Main Results:
- Of 807 individuals, 71 (8.8%) died by 2015.
- Initially, poverty was associated with increased mortality risk (HR 2.14).
- After adjusting for disease damage and age, this association disappeared (HR 1.68).
- Poor individuals who died lived significantly fewer years (13.9 years less).
Conclusions:
- The primary mechanism linking poverty to higher mortality in SLE is through increased disease damage accumulation.
- Disease damage mediates the effect of poverty on mortality in systemic lupus erythematosus.
- Poverty's impact on SLE mortality is largely explained by its contribution to disease severity and damage.
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