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4 Ways Race Impacts SLE Treatment and Severity

Posted on December 29, 2022
Medically reviewed by
Zeba Faroqui, M.D.
Article written by
Eleesha Lockett, M.S.

Communities of color in the United States often face disparate health outcomes, especially among those living with chronic health conditions. Systemic lupus erythematosus (SLE), often simply referred to as lupus, is a type of autoimmune disease that disproportionately affects people of color.

Researchers report that rates of SLE among women are about nine times that of men, and those of color are disproportionately affected: According to statistics from the Manhattan Lupus Surveillance Program (MLSP), non-Hispanic Black women have the highest rate of SLE, at a prevalence (or disease rate) roughly three times that of non-Hispanic white women. Prevalence was about two times higher in Hispanic women and 1.4 times higher in Asian women than in white women.

SLE is also more prevalent among non-Hispanic Black, Hispanic, and Asian men than in white men, the study authors reported. Compared to white men, the prevalence of SLE is roughly seven times higher in Black men, five times higher in Hispanic men, and four times higher in Asian men, according to their findings.

However, it’s not just higher disease prevalence that affects particular populations. People of color with SLE also experience vast differences, or racial disparities, in the severity of disease complications, pregnancy outcomes, and overall death rates, for example.

Ahead, we’ll explore some of the ways that racial disparities affect SLE treatment and severity in certain racial and ethnic groups — and discuss what you can do to advocate for yourself as a person of color living with SLE.

1. Black People Develop Lupus at a Younger Age

Lupus tends to develop at a younger age in Black people than in white people. For example, the National Lupus Patient Registry in Georgia found that lupus rates are three times higher in Black females than in white females — especially among those ages 30 to 39. A different study found that the average age of lupus diagnosis was six years younger in African Americans than in white people.

There is some evidence that genetic factors may play a role in earlier SLE onset among African Americans. However, the precise reason for this difference is not well understood.

It’s important to receive care as soon as possible when lupus symptoms appear — earlier onset of symptoms can have negative consequences on health and quality of life. “These are young women in the prime of their careers, family, and fertility. This means a severely compromised future, with a disease that waxes and wanes, affecting every aspect of daily living for the rest of their lives,” the lead researcher of the Georgia study said in a press release.

2. People of Color Experience More Severe Lupus Complications

A higher proportion of Black women also experience lupus complications compared with white women, according to the Lupus Foundation of America. Complications include lupus nephritis (lupus-related kidney disease), end-stage renal disease (kidney failure), and neurological disease.

Other racial and ethnic groups are also disproportionately affected by lupus complications. A 2019 study found that African American, Asian/Pacific Islander, and Hispanic people living with lupus had higher rates of kidney complications, neurological complications, and blood disorders, compared to white people living with the condition. In the MLSP data, the prevalence of lupus nephritis was as high as 53.2 percent in Asian people, 50.7 percent in Black people, and 49.4 percent in Hispanic people — versus 25.4 percent among white people.

3. Black and Hispanic People With SLE Face Worse Pregnancy Outcomes

Anyone who has SLE is at high risk of complications during pregnancy. However, both Black and Hispanic people living with SLE have higher rates of certain pregnancy complications than those who are white. A 2016 study found that nearly 25 percent of Black and 21 percent of Hispanic women had preterm labor, as opposed to roughly 14 percent of white women. Preeclampsia affected almost 20 percent of Black and Hispanic women with SLE during pregnancy, compared with 13.5 percent of white women. Rates of cesarean section were over 40 percent for all three groups.

The many possible reasons for the increased risk of complications in people of color include lupus complications outside of pregnancy, according to the study authors. For example, lupus nephritis, which is more common in Black and Hispanic people with SLE, is a predictor of complications like preeclampsia and preterm birth. Other possible risk factors for pregnancy complications noted by the researchers include:

  • Higher rates of chronic health conditions
  • Lower socioeconomic status
  • Poor quality of health care

4. People of Color Living With SLE Have Higher Mortality Rates

SLE can also have a huge impact on mortality rates, especially in Black women, according to researchers. Statistics from the Georgia Lupus Registry show that Black people with SLE had the same proportion of deaths in a two-year period as white people with SLE did in 10 years.

The Georgia registry findings also show that, among those with SLE, Black people had a higher risk of death sooner after diagnosis and died roughly 13 years sooner than white people. The risk of death after diagnosis remained low for up to five years after diagnosis for white people but was “significantly and persistently higher” for Black people, the researchers wrote.

People of color also appear to be disproportionately affected when hospitalized with complications from SLE. A 2020 study published in the journal Arthritis Care & Research reported that Black, Hispanic, and Asian/Pacific Islander people with SLE were more likely to die during hospitalization than white people with SLE.

How To Advocate for Yourself When Living With SLE

Racial disparities in public health care can significantly impact the diagnosis, treatment, and management of SLE in people of color. But through research, advocacy, and education, we can begin to improve the quality of life for people of color living with lupus.

If you are living with lupus, here are some steps you can take to advocate for yourself, from diagnosis to treatment and beyond.

1. Learn About the Warning Signs of SLE Complications

SLE complications like kidney disease disproportionately affect people of color, so it’s important to be familiar with the symptoms of these other conditions. For example, symptoms of lupus nephritis include:

  • Foamy urine
  • Blood in the urine
  • Swollen hands and feet

Other lupus complications include heart attack and stroke. Cardiovascular disease (heart disease) is the top cause of death in individuals with lupus across racial groups. Talk to your doctor about complications of lupus and their symptoms and any steps you can take to care for your health.

2. Seek Out Health Care Providers Who Understand Your Needs

Research suggests that people of color often receive a lower quality of care from health care providers, often because of racial discrimination and bias. One way to address this is to seek out culturally competent doctors and specialists who can understand and address your unique needs.

You can research specialists online by reading their bios on practice websites. Consider where a provider was trained or previously practiced, which might suggest if they have experience in treating diverse populations. You can also connect with people in lupus support groups to get referrals from others who live near you.

Depending on your geographic location and insurance provider, you may not have many options for lupus specialists. It might also be challenging to find a rheumatologist of your same racial or ethnic background. Even if you have limited choices, you may be able to learn what to expect from a specific doctor from individuals you meet in your area.

3. Prepare for Doctors’ Appointments

Planning ahead for appointments can help you make the most of your time with your rheumatologist. Take some time to write down your questions and reflect on how lupus affects your life. Speaking up about your concerns regarding symptoms, treatments, or quality of life — even if your doctor doesn’t directly ask you about a specific issue — can help ensure your needs are met.

Your rheumatologist will ask about your family history, so check with family members to learn if anyone else has been diagnosed with SLE or experienced symptoms, such as:

  • Joint pain
  • Rashes
  • Oral or nasal sores

4. Build Your Support System

Building a strong support system of people with lupus can help you be your best health advocate. In addition to connecting with people on MyLupusTeam, look for support groups in your area so you can ask questions about others’ experiences and share your own. Doing so may help you connect with resources you weren’t aware of before and can bolster you during hard times with your illness.

Meet Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 218,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Are you a person of color living with SLE or another type of lupus? Have you taken steps to advocate for yourself? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. The Incidence and Prevalence of Systemic Lupus Erythematosus in New York County (Manhattan), New York: The Manhattan Lupus Surveillance Program — Arthritis & Rheumatology
  2. Black Women Develop Lupus at Younger Age With More Life-Threatening Complications — Lupus Foundation of America
  3. Differences by Race, Sex and Age in the Clinical and Immunologic Features of Recently Diagnosed Systemic Lupus Erythematosus Patients in the Southeastern United States — Lupus
  4. Population-Based Incidence and Prevalence of Systemic Lupus Erythematosus — Arthritis & Rheumatology
  5. Racial and Ethnic Differences in the Prevalence and Time to Onset of Manifestations of Systemic Lupus Erythematosus: The California Lupus Surveillance Project — Arthritis Care & Research
  6. Racial and Ethnic Disparities in the Pregnancies of Women With Systemic Lupus Erythematosus — Arthritis Care & Research
  7. Racial Disparities in Mortality Associated With Systemic Lupus Erythematosus — Fulton and DeKalb Counties, Georgia, 2002–2016 — Morbidity and Mortality Weekly Reports
  8. Mortality Among Hospitalized Individuals With Systemic Lupus Erythematosus in the US Between 2006 and 2016 — Arthritis Care & Research
  9. Lupus Nephritis — Mayo Clinic
  10. Lupus Complications and Prognosis — Johns Hopkins Medicine
  11. Health Service Utilization Among African American Women Living With Systemic Lupus Erythematosus: Perceived Impacts of a Self-Management Intervention — Arthritis Research & Therapy
  12. Equity in Health Care — Arthritis Foundation
    All updates must be accompanied by text or a picture.
    Zeba Faroqui, M.D. earned her medical degree from the SUNY Downstate College of Medicine. Learn more about her here.
    Eleesha Lockett, M.S. is a nutrition professional and freelance writer who specializes in crafting empathetic, inclusive, and accurate health and wellness content. Learn more about her here.

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