Disparities in lupus care and outcomes

Demas, Kristina; Costenbader, Karen H.

doi:10.1097/bor.0b013e328323daad

Cited by 98 publications

(98 citation statements)

References 84 publications

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“…16 Likewise, our findings help to identify specific populations that require further study but do not address all potential contributors to disease severity and poor outcomes in children with SLE.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Hospitalized Pediatric Patients With Systemic Lupus Erythematosus

Son¹,

Johnson

Hersh

et al. 2014

Pediatrics

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OBJECTIVE: Disparities in outcomes among adults with systemic lupus erythematosus (SLE) have been documented. We investigated associations between sociodemographic factors and volume of annual inpatient hospital admissions with hospitalization characteristics and poor outcomes among patients with childhood-onset SLE. METHODS: By using the Pediatric Health Information System, we analyzed admissions for patients aged 3 to <18 years at index admission with ≥1 International Classification of Diseases, Ninth Revision code for SLE from January 2006 to September 2011. Summary statistics and univariable analyses were used to examine demographic characteristics of hospital admissions, readmissions, and lengths of stay. We used multivariable logistic regression analyses, controlling for patient gender, age, race, ethnicity, insurance type, hospital volume, US census region, and severity of illness, to examine risk factors for poor outcomes. RESULTS: A total of 10 724 admissions occurred among 2775 patients over the study period. Hispanic patients had longer lengths of stay, more readmissions, and higher in-hospital mortality. In multivariable analysis, African American race was significantly associated with ICU admission. African American race and Hispanic ethnicity were associated with end-stage renal disease and death. Volume of patients with SLE per hospital and hospital location were not significantly associated with outcomes. CONCLUSIONS: In this cohort of hospitalized children with SLE, race and ethnicity were associated with outcomes. Further studies are needed to elucidate the relationship between sociodemographic factors and poor outcomes in patients with childhood-onset SLE.

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Section: Discussionmentioning

confidence: 99%

Outcomes in Hospitalized Pediatric Patients With Systemic Lupus Erythematosus

Son¹,

Johnson

Hersh

et al. 2014

Pediatrics

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“…Much of this variability concerns the assessment of organ involvement, complicating comparisons among practices and potentially leading to poor outcomes 1 2…”

Section: Introductionmentioning

confidence: 99%

European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies

Mosca

Tani

Aringer

et al. 2009

Annals of the Rheumatic Diseases

336

216

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Objectives-To develop recommendations for monitoring patients with systemic lupus erythematosus (SLE) in clinical practice and observational studies and to develop a standardised core set of variables to monitor SLE.Methods-We followed the European League Against Rheumatism (EULAR) standardised procedures for guideline development. The following techniques were applied: nominal groups, Delphi surveys for prioritisation, small group discussion, systematic literature review and two Delphi rounds to obtain agreement. The panel included rheumatologists, internists, dermatologists, a nephrologist and an expert related to national research agencies. The level of evidence and grading of recommendations were determined according to the Levels of Evidence and Grades of Recommendations of the Oxford Centre for Evidence-Based Medicine.Results-A total of 10 recommendations have been developed, covering the following aspects: patient assessment, cardiovascular risk factors, other risk factors (osteoporosis, cancer), infection risk (screening, vaccination, monitoring), frequency of assessments, laboratory tests, mucocutaneous involvement, kidney monitoring, neuropsychological manifestations and ophthalmology assessment. A 'core set' of minimal variables for the assessment and monitoring of patients with SLE in clinical practice was developed that included some of the recommendations. In addition to the recommendations, indications for specific organ assessments that were viewed as part of good clinical practice were discussed and included in the flow chart.Conclusions-A set of recommendations for monitoring patients with SLE in routine clinical practice has been developed. The use of a standardised core set to monitor patients with SLE should facilitate clinical practice, as well as the quality control of care for patients with SLE, and the collection and comparison of data in observational studies.

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“…Among rheumatic diseases, systemic lupus erythematosus (SLE) has one of the highest mortality rates and highest rates of health disparity [2]. SLE disproportionately affects African Americans, particularly female African Americans, who have nearly threefold higher incidence of SLE compared to Caucasians [3].…”

Section: Introductionmentioning

confidence: 99%

Phenome-wide association study identifies marked increased in burden of comorbidities in African Americans with systemic lupus erythematosus

et al. 2018

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BackgroundAfrican Americans with systemic lupus erythematosus (SLE) have increased renal disease compared to Caucasians, but differences in other comorbidities have not been well-described. We used an electronic health record (EHR) technique to test for differences in comorbidities in African Americans compared to Caucasians with SLE.MethodsWe used a de-identified EHR with 2.8 million subjects to identify SLE cases using a validated algorithm. We performed phenome-wide association studies (PheWAS) comparing African American to Caucasian SLE cases and African American SLE cases to matched non-SLE controls. Controls were age, sex, and race matched to SLE cases. For multiple testing, a false discovery rate (FDR) p value of 0.05 was used.ResultsWe identified 270 African Americans and 715 Caucasians with SLE and 1425 matched African American controls. Compared to Caucasians with SLE adjusting for age and sex, African Americans with SLE had more comorbidities in every organ system. The most striking included hypertension odds ratio (OR) = 4.25, FDR p = 5.49 × 10− 15; renal dialysis OR = 10.90, FDR p = 8.75 × 10− 14; and pneumonia OR = 3.57, FDR p = 2.32 × 10− 8. Compared to the African American matched controls without SLE, African Americans with SLE were more likely to have comorbidities in every organ system. The most significant codes were renal and cardiac, and included renal failure (OR = 9.55, FDR p = 2.26 × 10− 40) and hypertensive heart and renal disease (OR = 8.08, FDR p = 1.78 × 10− 22). Adjusting for race, age, and sex in a model including both African American and Caucasian SLE cases and controls, SLE was independently associated with renal, cardiovascular, and infectious diseases (all p < 0.01).ConclusionsAfrican Americans with SLE have an increased comorbidity burden compared to Caucasians with SLE and matched controls. This increase in comorbidities in African Americans with SLE highlights the need to monitor for cardiovascular and infectious complications.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1561-8) contains supplementary material, which is available to authorized users.

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Disparities in lupus care and outcomes

Cited by 98 publications

References 84 publications

Outcomes in Hospitalized Pediatric Patients With Systemic Lupus Erythematosus

Outcomes in Hospitalized Pediatric Patients With Systemic Lupus Erythematosus

European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies

Phenome-wide association study identifies marked increased in burden of comorbidities in African Americans with systemic lupus erythematosus

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