Outcomes in patients with systemic lupus erythematosus (SLE) are largely influenced by level of poverty, type of neighborhood of residence, and chronic stress, according to the results of a series of extensive qualitative, structured interviews that were conducted in individuals with SLE as part of the Lupus Outcomes Study. Findings were published in Arthritis Care & Research.
The investigators sought to obtain the perspectives of individuals with SLE regarding the role of poverty, neighborhood, and persistent stress in disease outcomes. A total of 723 individuals with SLE were followed between 2003 and 2015 using annual structured interviews in order to establish the effect of poverty, persistent poverty, living in a neighborhood of concentrated poverty, access to healthcare, and chronic stress on accumulated damage in the disease. Based on household income, geography, and outcomes from their last interview, the researchers systematically sampled 28 of the 723 individuals from the larger study and administered qualitative interviews to explore their views on how these factors were linked to SLE outcomes.
Individuals living in poverty often reported that their impoverishment necessitated a choice regarding how to deal with food, housing insecurity, and medical care on a daily basis, and to relegate dealing with SLE to those times when they experienced disease flares. In addition, these individuals indicated that exposure to crime in their neighborhoods was a stress that was associated with worsened disease activity. In contrast, participants who were affluent reported that their neighborhood neither helped nor hindered the way in which they dealt with SLE, as they relied on networks not tied to neighborhoods to deal with their disease.
This study is the first of its kind to verify that attention to securing adequate food, housing, and medical care relegates SLE disease activity to a secondary concern, except at times of disease flare. Moreover, the study is also the first to document the extent to which experiencing or being fearful of crime is a stress that affects impoverished individuals with SLE.
The investigators concluded that reducing poverty, lessening exposure to crime by moving to safer neighborhoods, and the stress associated with financial insecurity are all factors identified by patients with SLE as being critical for predicting disease outcomes.
Yelin E, Trupin L, Bunde J, Yazdany J. Poverty, neighborhoods, persistent stress, and SLE outcomes: a qualitative study of the patients’ perspective [published online May 21, 2018]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23599