Neighborhood Socioeconomic Status and Short-Term Functional Outcomes in Systemic Lupus Erythematosus

Individuals with systemic lupus erythematosus (SLE) can accumulate functional status (FS) impairment. We evaluated the association between neighborhood socioeconomic disadvantage, as measured by the Area Deprivation Index (ADI), and FS in a national SLE sample.

Data were derived from Rheumatology Informatics System for Effectiveness, a national electronic health record-based registry. Individuals aged ≥18 years old with at least two visits for SLE ≥30 days apart and at least one FS assessment measure in 2016 to 2022 were included. ADI was grouped into quintiles. Cross-sectionally, mean FS scores were compared across ADI quintiles, and multilevel regression models were used to examine the association between ADI and FS score. Similarly, a multilevel model was used to assess the association between ADI and FS decline.

Mean (±SD) age in the cross-sectional cohort (N = 20,620) was 56.0 (±15.5) years; 91.4% were female, and 57.6% were non-Hispanic White. Baseline characteristics were similar in the longitudinal cohort (N = 10,604). Adjusted mean FS scores (interquartile range [IQR]) were higher (worse) among those with higher ADI (ADI quintile 1 [highest socioeconomic status (SES)]: 1.53 [1.28-1.77]; quintile 5 [lowest SES]: 1.90 [1.63-2.16]). In the longitudinal cohort, 15.7% experienced FS decline. The proportion of patients with FS decline (IQR) was greater with decreases in ADI (quintile 1: 11.4% [9.3%-13.5%]; quintile 5: 17.0% [13.7%-20.2%]).

In this national sample of adults with SLE, greater neighborhood deprivation was associated with worse physical function and a higher likelihood of short-term functional decline. Clinical efforts to improve outcomes should include routine assessment of function and patient-centered interventions that acknowledge and help mitigate social and structural barriers to health.