Racial Disparities in the Incidence of Primary Chronic Cutaneous Lupus Erythematosus in the Southeastern US: The Georgia Lupus Registry

Drenkard, Cristina; Parker, Sareeta; Aspey, Laura; Gordon, Caroline; Helmick, Charles G.; Bao, Gaobin; Lim, S. Sam

doi:10.1002/acr.23578

Cited by 44 publications

(50 citation statements)

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“…The Swedish study provided a pDLE rate of 3.2 per 100 00018 while the study from French Guiana, with a predominantly African population, reported an annual chronic CLE incidence of 2.6 per 100 000 population (of which 90% were pDLE) 19. In line with our findings, both the Minnesota study as well as the Swedish study found that prevalent and incident pDLE were higher among women compared with men and most common in middle-aged women 7 17 18. The Minnesota study also reported rates of CLE by race/ethnicity,17 but these rates are not comparable given the predominantly white population (90.3%) included in that analysis.…”

Section: Discussionsupporting

confidence: 85%

“…Our more restrictive secondary definition required evidence that the diagnosis was stated by a rheumatologist or dermatologist. Given the MLSP did not approach dermatology practices and only rarely had access to hospital-associated dermatology clinics as a case-finding source, we did not want to further underestimate the burden of DLE by also requiring evidence of a biopsy, which is not always performed 7. Thus, we did not require evidence of a compatible diagnostic biopsy for either definition.…”

Section: Methodsmentioning

confidence: 99%

“…DLE can also occur in the absence of SLE, referred to as primary DLE (pDLE). The extant epidemiological data on pDLE remain limited with few published estimates for the general population and scant data for racial/ethnic populations in the USA 7…”

Section: Introductionmentioning

confidence: 99%

“…The Manhattan Lupus Surveillance Program (MLSP) is one of five Centers for Disease Control and Prevention (CDC)–funded population-based registries composed of patients with SLE and related diseases 1–4 8. Recently, the Georgia Lupus Registry (GLR) reported an overall age-adjusted incidence of pDLE of 3.7 per 100 000 person-years, with a black:white ratio of 5.3 7. We used MLSP data to provide estimates of the prevalence and incidence of pDLE during 2007 and 2007–2009, respectively, in Manhattan which is characterised by a more diverse population (non-Latino black, Latino, non-Latino Asian, non-Latino white) than the GLR.…”

Section: Introductionmentioning

confidence: 99%

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Population-based prevalence and incidence estimates of primary discoid lupus erythematosus from the Manhattan Lupus Surveillance Program

et al. 2019

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ObjectiveEpidemiological data for primary discoid lupus erythematosus (pDLE) remain limited, particularly for racial/ethnic populations in the USA. The Manhattan Lupus Surveillance Program (MLSP) is a population-based retrospective registry of cases with SLE and related diseases including pDLE in Manhattan and was used to provide estimates of the prevalence and incidence of pDLE across major racial/ethnic populations.MethodsMLSP cases were identified from rheumatologists, hospitals and population databases. Two case definitions were used for pDLE: the primary case definition which was any physician diagnosis found in the chart and a secondary case definition which was limited to cases diagnosed by a rheumatologist and/or dermatologist. Rates among Manhattan residents were age-adjusted, and capture–recapture analyses were conducted to assess case under-ascertainment.ResultsBased on the primary definition, age-adjusted overall prevalence and incidence rates of pDLE among Manhattan residents were 6.5 and 0.8 per 100 000 person-years, which increased to 9.0 and 1.3 after capture–recapture adjustment. Prevalence and incidence rates were approximately two and six times higher, respectively, among women compared with men (p<0.0001). Higher prevalence was also found among non-Latino blacks (23.5) and Latinos (8.2) compared with non-Latino whites (1.8) and non-Latino Asians (0.6) (p<0.0001). Incidence was highest among non-Latino blacks (2.4) compared with all other racial/ethnic groups. Similar relationships were observed for the secondary case definition.ConclusionData from the MLSP provide epidemiological estimates for pDLE among the major racial/ethnic populations in the USA and reveal disparities in pDLE prevalence and incidence by sex and race/ethnicity among Manhattan residents.

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Section: Discussionsupporting

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Population-based prevalence and incidence estimates of primary discoid lupus erythematosus from the Manhattan Lupus Surveillance Program

et al. 2019

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“…The incidence and severity of some autoimmune skin diseases can vary depending on gender, age, and ethnicity of the population . Previous studies of connective tissue diseases, particularly discoid lupus erythematosus (DLE), have shown a predilection for patients of African descent, and black patients have been shown to experience skin damage early in their disease course …”

Section: Introductionmentioning

confidence: 99%

Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review

et al. 2018

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The incidence of autoimmune skin diseases in Botswana is lower compared to other published studies in other geographic areas, which may be reflective of a younger population, barriers to access, genetic differences, and a lack of comparative studies in sub-Saharan Africa. The hygiene hypothesis and helminth infections may also contribute to these differences. Further studies are needed to understand these disorders in this region.

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Area Deprivation and Disease Severity in Adult Patients With Discoid Lupus Erythematosus

Faden,

Xie,

Stone

et al. 2024

JAMA Dermatol

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ImportanceThe association of area deprivation with outcomes in discoid lupus erythematosus (DLE) remains poorly understood.ObjectiveTo determine the association between US Census block measures of deprivation and disease severity in adult patients with DLE.Design, Setting, and ParticipantsThis cross-sectional study included 154 patients with DLE seen between January 1, 2007, and January 1, 2024, at a single-center referral-based specialty rheumatologic-dermatology clinic in Philadelphia, Pennsylvania. Patients were aged 18 to 73 years and were enrolled in the University of Pennsylvania’s Cutaneous Lupus Erythematosus Database study. Data were analyzed between January 1, 2024, and May 8, 2024.ExposuresResidence in a highly disadvantaged area as geocoded by a state area deprivation index (ADI).Main Outcomes and MeasuresThe main outcome was DLE disease severity as codified by the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) damage and activity scores.ResultsA total of 154 adult patients with DLE (128 women [83%] and 26 men [17%]; mean [SD] age, 43 [13] years; 6 [4%] Asian individuals, 98 [64%] Black individuals, 2 [1%] Hispanic individuals, 46 [30%] White individuals, and 2 individuals [1%] with other race or ethnicity; 78 [51%] with an ADI &gt;5; 43 who currently smoked [28%];and 56 [36%] with concurrent systemic lupus erythematosus) were included in the analysis. By multivariable logistic regression, residence within communities with an ADI greater than 5 was associated with nearly 4-fold greater odds of moderate to severe damage (odds ratio [OR], 3.90; 95% CI, 1.27-12.69] and activity (OR, 3.31; 95% CI, 1.27-9.44). Concurrent cigarette smoking was similarly associated with greater odds of moderate to severe damage (OR, 3.15; 95% CI, 1.09-10.29). After controlling for ADI and other confounders, race was not significantly associated with DLE disease severity.Conclusions and RelevanceThe results of this cross-sectional study suggest that geospatial disadvantage is associated with DLE disease severity independent of race. This invites a paradigm shift that considers the social context within which racial disparities are observed, highlighting the potential for geographically targeted interventions and policy changes to improve patient outcomes in DLE.

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Racial Disparities in the Incidence of Primary Chronic Cutaneous Lupus Erythematosus in the Southeastern US: The Georgia Lupus Registry

Cited by 44 publications

References 34 publications

Population-based prevalence and incidence estimates of primary discoid lupus erythematosus from the Manhattan Lupus Surveillance Program

Population-based prevalence and incidence estimates of primary discoid lupus erythematosus from the Manhattan Lupus Surveillance Program

Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review

Area Deprivation and Disease Severity in Adult Patients With Discoid Lupus Erythematosus

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