The Role of Socioeconomic Status on Development of End-Stage Renal Disease for those with Lupus Nephritis Public

Abstract

Background: Systemic lupus erythematosus (SLE) is a potentially fatal chronic autoimmune
disease that can affect multiple systems of the body. SLE causes inflammation to the kidneys in
up to 60% of cases, leading to lupus nephritis. Lupus nephritis is a serious condition that can lead
to end-stage renal disease (ESRD) which is treated with dialysis or a renal transplant. African
Americans have poorer outcomes with lupus nephritis compared to whites. This difference
cannot be fully explained by biologic or genetic factors. The aim of this study was to determine
if there is an association between socioeconomic status (SES) and progression of ESRD for those
with lupus nephritis.
Methods: 558 African American and White Patients with lupus nephritis were identified from
The Georgia Lupus Registry, a population-based registry of patients with lupus in a large
Metropolitan area of Atlanta. ESRD status was gathered from the Centers for Medicare &
Medicaid Services (CMS) Medical Evidence Report (Form CMS-2728), which is filled out for
patients receiving ESRD treatment. SES was determined using a social deprivation index, which
examined a patient's neighborhood environment, using the 2000 U.S. Census tract information
corresponding to the patient's home address between 2002 and 2004. Univariate and
Multivariate logistic regression was performed to determine the association between SES and
developing ESRD.
Results: Multivariate analysis did not reveal an association between SES and the development of
ESRD in those with lupus nephritis. In particular, there was no difference between the second
quartile and first quartile (aOR 1.44 (95% CI 0.74-2.78)), between the second quartile and third
quartile (aOR 1.23 (95% CI 0.66-2.28)), and between the second quartile and fourth quartile
(aOR 1.70 (95% CI 0.93-3.08)).
Conclusion: SES, derived from the social deprivation index, was not associated with increased
risk of developing ESRD among those with lupus nephritis. Nevertheless, since SES was
measured at the neighborhood level, it is possible that SES may be associated with developing
ESRD if SES is measured at the individual level.

Table of Contents

TABLE OF CONTENTS

Background………………………………………………………………………………………...1
Methods…………………………………………………………………………………………….8
Results…………………………………………………………………………………………….15
Discussion………………………………………………………………………………………...22
References………………………………………………………………………………………...27
Tables……………………………………………………………………………………………..30

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Socioeconomic Status Systemic Lupus Erythematosus Lupus Nephritis End-Stage Renal Disease
Committee Chair / Thesis Advisor	Kleinbaum, David, Emory University
Committee Members	Drenkard, Cristina M, Emory University Lim, S Sam, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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