Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus

Abstract

Systemic Lupus erythematosus (SLE) is 3 times more common and its’ manifestations more severe in African American (AA) women compared to women of other races. It is not clear whether this is due to genetic differences or factors related to the physical or social environments, differences in health care or a combination of these factors. Health disparities in SLE between AAs and persons of other races have been reported since the 1960's and are correlated with measures of lower socioeconomic status. Risk factors for these disparities have been demonstrated but whether their mitigation improves outcomes for AA patients has not been tested except in self‐efficacy. In 2002, Sacks conducted the first true U.S. population‐based study of SLE with death certificate records and demonstrated a wide disparity between the number of AA women and white women dying from SLE. Five years ago, Yen showed that SLE mortality in the U.S. had improved, but that the AA mortality disparity persisted. Between 2014 and 2021 Lim and others demonstrated racism's deleterious effects in SLE. Racism may have been the unmeasured confounder, the proverbial “elephant in the room” – unnamed and unstudied. The etymology of “risk factor” has evolved from environmental risk factors to social determinants to now include structural injustice/structural racism. Racism in the U.S. has centuries long existence and is deeply ingrained and intertwined making its detection and resolution difficult. However, its being man‐made means mankind can choose to change the situation. Health disparities in SLE should be addressed by viewing healthcare as a basic human right. We offer a conceptual framework and goals for both individual and national actions.