Racial and Ethnic Disparities Within Social Determinants of Health Amongst Patients With Systemic Lupus Erythematosus

TL;DR

This study shows that racial and ethnic disparities in social factors like transportation and healthcare access affect patients with lupus differently.

Contribution

The study highlights specific racial and ethnic disparities in social determinants of health among systemic lupus erythematosus patients using a large national dataset.

Findings

African Americans, Asians, and Whites had differing perceptions of neighborhood safety and healthcare provider respect.

Hispanic participants reported higher crime rates, felt unsafe at night, and experienced greater food insecurity compared to non-Hispanic participants.

Disparities in transportation access, food security, and provider respect were statistically significant across racial and ethnic groups.

Abstract

Introduction

This study aims to identify the influence of social determinants of health (SDoH) on patients with systemic lupus erythematosus (SLE), emphasizing racial and ethnic disparities in healthcare.

Methods

A cross-sectional study used the National Institute of Health’s (NIH) All of Us Research Program (AoU). From 727,000 patients, SLE patients were categorized by race, ethnicity, and responses to the Social Determinants of Health survey from May 2018 until March 2023. Survey questions addressed transportation access, neighborhood safety, provider biases, and food insecurity. JMP Pro 16.0 and R 4.2.2 were used for statistical analysis.

Results

Significant racial disparities were evident amongst SLE patients for transportation access, neighborhood safety, food security, and respect from healthcare providers (p-value < 0.001). African Americans, Asians, and White participants showed different perceptions regarding neighborhood crime, healthcare provider courtesy, and feeling unheard by providers, with respective p-values of 0.001, 0.010, and 0.023. Hispanic participants perceived higher neighborhood crime rates, felt unsafe during nighttime walks, felt unheard by healthcare providers, and reported worrying about food security compared to non-Hispanic participants, with respective p-values of 0.003, 0.003, 0.009, and <0.001.

Discussion

SLE is affected by access to care, treatments, stress, and lifestyle habits. Therefore, identifying SDoH for SLE patients is critical as it impacts disease progression, leading to delays in diagnosis, improper management, and worsening morbidity.

Conclusion

Targeted social and community-based interventions may improve access to care, identify implicit biases among providers, and alleviate food insecurity.

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