Disparities in Lupus Care and Outcomes
Disparities in Lupus Care and Outcomes
Purpose of Review: Systemic lupus erythematosus (SLE), an inflammatory rheumatic disease characterized by autoantibody production and diverse clinical manifestations, disproportionately affects vulnerable groups: women, racial and ethnic minorities, the poor and those lacking medical insurance and education. We summarize the current knowledge of the disparities observed in SLE and highlight recent research that aims to dissect the causes of these disparities and identify the potentially modifiable factors contributing to them.
Recent Findings: Several remediable causes, including lack of education, self-efficacy and access to quality, experienced healthcare have been found to contribute to observed disparities in SLE prevalence and outcomes.
Summary: SLE is associated with alarming disparities in incidence, severity and outcomes. The causes of these disparities are under study by several research groups. Identifying potentially correctable contributory factors should allow the development of effective strategies to improve the healthcare delivery and outcomes in all SLE patients.
Health disparities, according to the National Institutes of Health (NIH) Working Group on Health Disparities, have been defined as 'differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the US'. The study of disparities in health outcomes and their causes is now a national priority. Sociodemographic disparities in the incidence and severity of many chronic diseases, including obesity, hypertension, diabetes mellitus and chronic renal disease, have been observed. Vulnerable populations may be defined by age, race/ethnicity, sex, sexual orientation, socioeconomic status, geographic residence or other characteristics.
Of the numerous conceptual frameworks describing determinants of health outcomes disparities, a conceptual model articulated by House includes sociodemographic factors that are relatively fixed such as age, sex, race, ethnicity and geographic location and those that are potentially modifiable (Figure 1). The NIH Strategic Plan on Health Disparities focuses on differences in healthcare delivery, an important potentially modifiable factor in the pathway between belonging to a specific sociodemographic group and ultimate healthcare outcomes. Healthcare system factors, medical insurance and psychosocial factors, including adherence, education and social support are also potentially modifiable factors that may interact with fixed sociodemographic factors or act independently and influence long-term outcomes, creating health outcomes disparities.
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Figure 1.
Conceptual framework for understanding sociodemographic differences and disparities in systemic lupus erythematosus.
Abstract and Introduction
Abstract
Purpose of Review: Systemic lupus erythematosus (SLE), an inflammatory rheumatic disease characterized by autoantibody production and diverse clinical manifestations, disproportionately affects vulnerable groups: women, racial and ethnic minorities, the poor and those lacking medical insurance and education. We summarize the current knowledge of the disparities observed in SLE and highlight recent research that aims to dissect the causes of these disparities and identify the potentially modifiable factors contributing to them.
Recent Findings: Several remediable causes, including lack of education, self-efficacy and access to quality, experienced healthcare have been found to contribute to observed disparities in SLE prevalence and outcomes.
Summary: SLE is associated with alarming disparities in incidence, severity and outcomes. The causes of these disparities are under study by several research groups. Identifying potentially correctable contributory factors should allow the development of effective strategies to improve the healthcare delivery and outcomes in all SLE patients.
Introduction
Health disparities, according to the National Institutes of Health (NIH) Working Group on Health Disparities, have been defined as 'differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the US'. The study of disparities in health outcomes and their causes is now a national priority. Sociodemographic disparities in the incidence and severity of many chronic diseases, including obesity, hypertension, diabetes mellitus and chronic renal disease, have been observed. Vulnerable populations may be defined by age, race/ethnicity, sex, sexual orientation, socioeconomic status, geographic residence or other characteristics.
Of the numerous conceptual frameworks describing determinants of health outcomes disparities, a conceptual model articulated by House includes sociodemographic factors that are relatively fixed such as age, sex, race, ethnicity and geographic location and those that are potentially modifiable (Figure 1). The NIH Strategic Plan on Health Disparities focuses on differences in healthcare delivery, an important potentially modifiable factor in the pathway between belonging to a specific sociodemographic group and ultimate healthcare outcomes. Healthcare system factors, medical insurance and psychosocial factors, including adherence, education and social support are also potentially modifiable factors that may interact with fixed sociodemographic factors or act independently and influence long-term outcomes, creating health outcomes disparities.
(Enlarge Image)
Figure 1.
Conceptual framework for understanding sociodemographic differences and disparities in systemic lupus erythematosus.
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