Investigation of Systemic Lupus Erythematosus in Nogales, Arizona

Abstract

In 1996, a citizens group in Nogales, Arizona, reported to the Arizona Department of Health their concerns about a possible excess prevalence of systemic lupus erythematosus (SLE) due to exposure to environmental contamination in the area. The authors conducted a two-phase study in which the objectives of phase I were to identify potential SLE cases and to determine the prevalence of SLE and the objectives of phase II were to identify potential risk factors associated with the development of SLE and to evaluate the possible association between SLE and environmental exposure to pesticides and inorganic compounds. Participants included 20 confirmed cases and 36 controls. The authors found the prevalence of SLE to be 103 cases per 100,000 population (95 percent confidence interval: 56, 149), two to seven times higher than the prevalence in the US population. They detected elevated levels of 1,1-dichloro-2,2-bis-(p-chorophenyl)ethylene and organophosphate metabolites among cases and controls. In both, levels were higher than the reference mean for the US population. The authors found no statistical association between elevated levels of pesticides and disease status. Their results show that the prevalence of SLE in Nogales is higher than the reported prevalence in the US population and that both cases and controls had past exposure to chlorinated pesticides and have ongoing exposure to organophosphates.

Ethnic disparities in patients with systemic lupus erythematosus

“…Ethnic disparities are likely to originate from differences in health-related behaviors (eating patterns, exercising, drinking, smoking, and recreational drug use), low-to-zero English proficiency (when living in English-speaking countries, eg, Hispanics), poor literacy level, inadequate healthrelated knowledge and beliefs, unhealthy environment exposures, stressors (divorce, joblessness, discrimination, migration, or relocation), inadequate coping strategies (relaying in prayer or wishful thinking) or social support (source, size, quality, and influence of the social network vary depending on ethnicity), limited access to health care and poor treatment adherence (financial resources, type of insurance, availability, care preference, and use of nontraditional remedies), lack of ethnic concordance between patient and clinician, patient's mistrust toward physician, clinician's bias toward minority patients, or lack of cultural sensitivity among health care providers [23,[33][34][35][36][37][38]. The influence of ethnicity on health and disease is complex, and encompasses a combination of these factors, which need measurement in comparative multiethnic studies of SLE so that researchers may fully understand their impact.…”

A structured literature review of the direct costs of adult systemic lupus erythematosus in the US

“…In particular, renal involvement is a major complication of SLE and is a strong determinant of associated morbidity and mortality. Typically, SLE is characterized by alternating periods of acute episodes (flare) and remission, with an estimated prevalence by 2000 ranging from approximately 100 -150 cases per 100,000 persons in the US (2,3). SLE is more prevalent in women, affecting females of childbearing age in 80 -90% of cases (4).…”

Effect of glutathione S‐TRANSFERASE polymorphisms and proximity to hazardous waste sites on time to systemic lupus erythematosus diagnosis: Results from the roxbury lupus project

“…Exposure to organic solvents, petroleum, and related by-products may play a role in susceptibility to SLE (17)(18)(19)(20)(21)(22). Solvent exposure has been associated with the risk of other autoimmune diseases, including scleroderma (23)(24)(25)(26), rheumatoid arthritis (27), and undifferentiated connective tissue disease (28), a chronic disease that shares clinical characteristics of SLE.…”