The following is the summary of “Trajectory of Damage Accrual in Systemic Lupus Erythematosus Based on Ethnicity and Socioeconomic Factors” published in the November 2022 issue of Rheumatology by Kallas, et al.

Higher scores on the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) predict higher healthcare costs and mortality. In a large prospective systemic lupus erythematosus (SLE) cohort, we evaluated the progression of total and individual damage items of the SDI between African American and White races. Researchers also evaluated the correlation between ethnicity and certain types of harm after controlling for a number of socioeconomic characteristics. The annual rate of damage to each organ was determined using Poisson regression. 

Ethnicity was utilized as an explanatory variable in a Cox regression model to examine the correlation between the delay in reporting damage and the severity of the damage. The demographics of the 2,436 patients we analyzed were 42.9% Black, 57.1% White, and 92.0% Female. There was no plateau in the average SDI score as a function of time post-diagnosis. After controlling for socioeconomic status, African American patients still had a higher rate of developing total, renal, pulmonary, and cutaneous damage than White patients did.

It is especially worrisome since harm has been increasing linearly in both populations over time. More damage was done more quickly in African American patients compared to White ones. While socioeconomic inequalities helped explain the greater rates of injury in African American patients for some organs, the disparity remained after controlling for these characteristics for the vast majority of organs.