Racial Discrimination, Disease Activity, and Organ Damage: The Black Women’s Experiences Living With Lupus (BeWELL) Study

• Published in: American journal of epidemiology 2019-08, Vol.188 (8), p.1434-1443
• Main Authors: Chae, David H, Martz, Connor D, Fuller-Rowell, Thomas E, Spears, Erica C, Smith, Tianqi Tenchi Gao, Hunter, Evelyn A, Drenkard, Cristina, Lim, S Sam
• Format: Article
• Language: English
• Subjects: African Americans; Autoimmune diseases; Chronic conditions; Confidence intervals; Cross-Sectional Studies; Damage; Discrimination; Female; Fever; Georgia - epidemiology; Healthcare Disparities - statistics & numerical data; Humans; Incidence; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - ethnology; Metropolitan areas; Middle Aged; Original Contributions; Prevalence; Questionnaires; Racial discrimination; Racism; Registries; Regression analysis; Severity of Illness Index; Signs and symptoms; Statistical analysis; Surveys and Questionnaires; Systemic lupus erythematosus; Ulcers
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kwz105

Abstract Black women are disproportionately affected by systemic lupus erythematosus (SLE), a chronic, potentially debilitating autoimmune disease, and they also experience more rapid progression and worse outcomes compared with other groups. We examined if racial discrimination is associated with disease outcomes among 427 black women with a validated diagnosis of SLE, who live in the Atlanta, Georgia, metropolitan area, and were recruited to the Black Women’s Experiences Living with Lupus Study (2015–2017). Frequency of self-reported experiences of racial discrimination in domains such as employment, housing, and medical settings was assessed using the Experiences of Discrimination measure. SLE activity in the previous 3 months, including symptoms of fatigue, fever, skin rashes, and ulcers, was measured using the Systemic Lupus Activity Questionnaire; irreversible damage to an organ or system was measured using the Brief Index of Lupus Damage. Results of multivariable linear regression analyses examining the Systemic Lupus Activity Questionnaire and log-transformed Brief Index of Lupus Damage scores indicated that increasing frequency of racial discrimination was associated with greater SLE activity (b = 2.00, 95% confidence interval: 1.32, 2.68) and organ damage (b = 0.08, 95% confidence interval: 0.02, 0.13). Comprehensive efforts to address disparities in SLE severity should include policies that address issues of racial discrimination.