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Economic Insecurities and patient-reported outcomes in patients with systemic lupus erythematosus in the USA: a cross-sectional analysis of data from the California Lupus Epidemiology Study
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2 2024
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Source: Lancet Rheumatol. 6(2):e105-e114
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Details:
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Alternative Title:Lancet Rheumatol
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Personal Author:
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Description:Background:
Social determinants of health (SDoH) are consistently associated with SLE outcomes; however, SDoH are typically measured with conventional socioeconomic status (SES) factors such as income or education. We assessed the association of economic insecurities (food, housing, healthcare, and financial insecurity) with patient-reported outcomes (PROs), over and above conventional SES measures, in an SLE cohort.
Methods:
Data were derived from the California Lupus Epidemiology Study (CLUES; n=252). Food, housing, healthcare, and financial economic insecurities were assessed by validated screening tools. PROs were obtained via PROMIS, Neuro-QoL, Patient Health Questionnaire (PHQ)-8, and General Anxiety Disorder (GAD)-7 instruments. Poverty was defined as household income ≤125% of the federal poverty limit. Lower education was defined as less than college-graduate education. The association of economic insecurities with PROs was assessed by multivariable linear regression models adjusting for demographics, lupus characteristics, and comorbidities. We tested for interactions of insecurities with poverty and education.
Findings:
Mean age was 49·7 ±13.4 years, and 91% (228/252) were female. 32% (80/252) self-identified as Asian, 10% (26/252) as Black, 40% (101/252) as White, 3% (8/252) as mixed race, and 14% (36/252) as other race. About a quarter (59/252) self-identified as Hispanic. 54% (135/252) had at least one insecurity. Insecurities were highly prevalent, and more common in those with poverty and lower education. Adjusted multivariate analyses revealed that participants with any insecurity had significantly worse scores across all PROs measured: Physical Function, no insecurity 48·9 (47·5, 50·3) vs. any insecurity 45·7 (44·3, 47·0); Pain Interference, 52·0 (50·5, 53·5) vs. 54·4 (53·0, 55·8); Fatigue, 50·5 (48·8, 52·3) vs. 54·9 (53·3, 56·5); Sleep Disturbance, 49·9 (48·3, 51·6) vs. 52·9 (51·4, 54·5); Cognitive Function, 49·3 (47·7, 50·9) vs. 45.6 (44·1, 47·0); PHQ-8, 4.4 (3·6, 5·1) vs. 6.1 (5·4, 6·8); and GAD-7, 3·3 (2·6, 4·1) vs. 5·2 (4·5, 5·9). Individuals with more insecurities exhibited worse PROs. There were no statistically significant interactions between insecurities and poverty or education.
Interpretation:
Having any economic insecurity was associated with worse outcomes for people with SLE regardless of poverty or education. Findings provide insight into the relationship between economic insecurities and SLE outcomes and underscore the need to study whether interventions that directly address these insecurities can reduce health disparities in this disease.
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Source:
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Pubmed ID:38267097
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Pubmed Central ID:PMC10964913
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Document Type:
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Funding:
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Volume:6
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Issue:2
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