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)

Permanent URL: https://etd.library.emory.edu/concern/etds/pz50gw89b?locale=en


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.

Table of Contents









About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Partnering Agencies
Last modified

Primary PDF

Supplemental Files