Discrimination is associated with Increased Disease Activity in African American Women with Systemic Lupus Erythematosus: A Study of the Georgians Against Lupus Cohort. Open Access
Harrison, Jordan Doane (2013)
Background/Purpose: Systemic lupus
erythematosus (SLE) is a multi-system autoimmune
disease that disproportionately impacts African American (AA) women
in their reproductive years. Furthermore, AA women with SLE
experience greater severity of disease and accelerated declines in
health, including higher rates of mortality compared to their White
counterparts. Recent studies have shown that AA women are more
likely to be the victims of discrimination and unfair treatment;
and such experiences, as sources of psychosocial stress, can
adversely impact the progression of chronic illnesses. The purpose
of our study was to examine the cross-sectional association between
self-reported discrimination and disease activity among AA women
with validated SLE.
Methods: Participants were from the Georgians Organized Against Lupus (GOAL) cohort, a population based sample of validated SLE patients in Atlanta, Georgia. As of 12/2011, 512 individuals returned research surveys, after exclusions, 399 AA females were included in the analysis dataset. Five items were used to assess the frequency of routine experiences of unfair treatment, including instances of being treated with less courtesy and respect, and receiving poorer service. SLE activity was measured using the Systemic Lupus Erythematous Activity Questionnaire (SLAQ). Multivariable linear regression models predicting the SLAQ were specified, controlling for sociodemographic and disease-related characteristics.
Results: In bivariate analysis, the SLAQ was greater in those who reported higher compared to lower levels of discrimination (20.8 ± 9.3 vs. 16.64 ± 8.9, p<.0001). BMI, work status, and marital status were also significantly associated with the SLAQ in bivariate analyses, but were not significant in multivariable models. In multivariable analyses, there was a significant positive relationship between UT and SLAQ even after adjustment for demographic, socioeconomic, behavioral, and other health-related covariates. In our final model, UT (β= 0.47, 95% CI: 0.27, 0.67, p < 0.001), as well as ratio of household income to poverty threshold (β= -1.23, 95% CI: -2.01, -0.44, p < 0.01) were significantly associated with the SLAQ.
Discussion: We found a positive association between discrimination and disease activity among AA women with SLE. This finding suggests that discrimination may be a risk factor for greater severity of disease in this population. Our study points to avenues for future research on the mechanisms underlying racial disparities in SLE severity.
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About this Master's Thesis
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