The relationship of socioeconomic status, race, and modifiable risk factors to outcomes in patients with systemic lupus erythematosus

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Abstract
Objective. To study the relationship of race, socioeconomic status (SES), clinical factors, and psychosocial factors to outcomes in patients with systemic lupus erythematosus (SLE). Methods. A retrospective cohort was assembled, comprising 200 patients with SLE from 5 centers. This cohort was balanced in terms of race and SES. Patients provided information on socioeconomic factors, access to health care, nutrition, self‐efficacy for disease management, health locus of control, social support, compliance, knowledge about SLE, and satisfaction with medical care. Outcome measures included disease activity (measured by the Systemic Lupus Activity Measure), damage (measured by the SLICC/ACR damage index), and health status (measured by the SF‐36). Results. In multivariate models that were controlled for race, SES, center, psychosocial factors, and clinical factors, lower self‐efficacy for disease management (P ≤ 0.0001), less social support (P < 0.005), and younger age at diagnosis (P < 0.007) were associated with greater disease activity. Older age at diagnosis (P ≤ 0.0001), longer duration of SLE (P ≤ 0.0001), poor nutrition (P < 0.002), and higher disease activity at diagnosis (P < 0.007) were associated with more damage. Lower self‐efficacy for disease management was associated with worse physical function (P ≤ 0.0001) and worse mental health status (P ≤ 0.0001). Conclusion. Disease activity and health status were most strongly associated with potentially modifiable psychosocial factors such as self‐efficacy for disease management. Cumulative organ damage was most highly associated with clinical factors such as age and duration of disease. None of the outcomes measured were associated with race. These results suggest that education and counseling, coordinated with medical care, might improve outcomes in patients with SLE.