TY - JOUR
T1 - Racial Disparities and Achievement of the Low Lupus Disease Activity State
T2 - A CARRA Registry Study
AU - The CARRA Registry Investigators
AU - Soulsby, William Daniel
AU - Olveda, Rebecca
AU - He, Jie
AU - Berbert, Laura
AU - Weller, Edie
AU - Barbour, Kamil E.
AU - Greenlund, Kurt J.
AU - Schanberg, Laura E.
AU - von Scheven, Emily
AU - Hersh, Aimee
AU - Son, Mary Beth F.
AU - Chang, Joyce
AU - Knight, Andrea
AU - Aamir, R.
AU - Abulaban, K.
AU - Adams, A.
AU - Aguiar Lapsia, C.
AU - Akinsete, A.
AU - Akoghlanian, S.
AU - Al Manaa, M.
AU - AlBijadi, A.
AU - Allenspach, E.
AU - Almutairi, A.
AU - Alperin, R.
AU - Amarilyo, G.
AU - Ambler, W.
AU - Amoruso, M.
AU - Angeles-Han, S.
AU - Ardoin, S.
AU - Armendariz, S.
AU - Asfaw, L.
AU - Aviran Dagan, N.
AU - Bacha, C.
AU - Balboni, I.
AU - Balevic, S.
AU - Ballinger, S.
AU - Baluta, S.
AU - Barillas-Arias, L.
AU - Basiaga, M.
AU - Baszis, K.
AU - Baxter, S.
AU - Becker, M.
AU - Begezda, A.
AU - Behrens, E.
AU - Beil, E.
AU - Benseler, S.
AU - Bermudez-Santiago, L.
AU - Bernal, W.
AU - Bigley, T.
AU - Bingham, C.
AU - Binstadt, B.
AU - Black, C.
AU - Blackmon, B.
AU - Blakley, M.
AU - Bohnsack, J.
AU - Boneparth, A.
AU - Bradfield, H.
AU - Bridges, J.
AU - Brooks, E.
AU - Brothers, M.
AU - Brunner, H.
AU - Buckley, L.
AU - Buckley, M.
AU - Buckley, M.
AU - Bukulmez, H.
AU - Bullock, D.
AU - Canna, S.
AU - Cannon, L.
AU - Canny, S.
AU - Cartwright, V.
AU - Cassidy, E.
AU - Castro, D.
AU - Chalom, E.
AU - Chang, J.
AU - Chang, M.
AU - Chang, J.
AU - Chang-Hoftman, A.
AU - Chen, A.
AU - Chiraseveenuprapund, P.
AU - Ciaglia, K.
AU - Co, D.
AU - Cohen, E.
AU - Collinge, J.
AU - Conlon, H.
AU - Connor, R.
AU - Cook, K.
AU - Cooper, A.
AU - Cooper, J.
AU - Corbin, K.
AU - Correll, C.
AU - Cron, R.
AU - Curry, M.
AU - Dalrymple, A.
AU - Datyner, E.
AU - Davis, T.
AU - De Ranieri, D.
AU - Dean, J.
AU - DeCoste, C.
AU - Dedeoglu, F.
AU - DeGuzman, M.
AU - Delnay, N.
AU - DeSantis, E.
AU - Devine, R.
AU - Dhalla, M.
AU - Dhanrajani, A.
AU - Dissanayake, D.
AU - Dizon, B.
AU - Drapeau, N.
AU - Drew, J.
AU - Driest, K.
AU - Du, Q.
AU - Duncan, E.
AU - Dunnock, K.
AU - Durkee, D.
AU - Dvergsten, J.
AU - Eberhard, A.
AU - Ede, K.
AU - Edelheit, B.
AU - Edens, C.
AU - El Tal, T.
AU - Elder, M.
AU - Elzaki, Y.
AU - Fadrhonc, S.
AU - Failing, C.
AU - Fair, D.
AU - Favier, L.
AU - Feldman, B.
AU - Fennell, J.
AU - Ferguson, P.
AU - Ferguson, I.
AU - Figueroa, C.
AU - Flanagan, E.
AU - Fogel, L.
AU - Fox, E.
AU - Fox, M.
AU - Franklin, L.
AU - Fuhlbrigge, R.
AU - Fuller, J.
AU - Furey, M.
AU - Futch-West, T.
AU - Gagne, S.
AU - Gennaro, V.
AU - Gerstbacher, D.
AU - Gilbert, M.
AU - Gironella, A.
AU - Glaser, D.
AU - Goh, I.
AU - Goldsmith, D.
AU - Gorry, S.
AU - Goswami, N.
AU - Gottlieb, B.
AU - Graham, T.
AU - Grevich, S.
AU - Griffin, T.
AU - Grim, A.
AU - Grom, A.
AU - Guevara, M.
AU - Hahn, T.
AU - Halyabar, O.
AU - Hamda Natur, M.
AU - Hammelev, E.
AU - Hammond, T.
AU - Harel, L.
AU - Harris, J.
AU - Harry, O.
AU - Hausmann, J.
AU - Hay, A.
AU - Hays, K.
AU - Hayward, K.
AU - Henderson, L.
AU - Henrickson, M.
AU - Hersh, A.
AU - Hickey, K.
AU - Hiraki, L.
AU - Hiskey, M.
AU - Hobday, P.
AU - Hoffart, C.
AU - Holland, M.
AU - Hollander, M.
AU - Hong, S.
AU - Horton, D.
AU - Horwitz, M.
AU - Hsu, J.
AU - Huber, A.
AU - Huberts, A.
AU - Huggins, J.
AU - Huie, L.
AU - Hui-Yuen, J.
AU - Ibarra, M.
AU - Imlay, A.
AU - Imundo, L.
AU - Inman, C.
AU - Jackson, A.
AU - James, K.
AU - Janow, G.
AU - Jared, S.
AU - Jiang, Y.
AU - Kitcharoensakkul, M.
AU - Schmitt, E.
AU - White, A.
N1 - Publisher Copyright:
© 2024 The Author(s). Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.
PY - 2025/1
Y1 - 2025/1
N2 - Objective: Differential disease control may contribute to racial disparities in outcomes of childhood-onset systemic lupus erythematosus (cSLE). We evaluated associations of race and individual- or neighborhood-level social determinants of health (SDoH) with achievement of low lupus disease activity state (LLDAS), a clinically relevant treatment target. Methods: In this cSLE cohort study using the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, the primary exposure was self-reported race and ethnicity, and collected SDoH included insurance status and area deprivation index (ADI). Outcomes included LLDAS, disease activity, and time-averaged prednisone exposure. Associations among race and ethnicity, SDoH, and disease activity were estimated with multivariable regression models, adjusting for disease-related and demographic factors. Results: Among 540 children with cSLE, 27% identified as Black, 25% identified as White, 23% identified as Latino/a, 11% identified as Asian, 9% identified as more than one race, and 5% identified as other. More Black children (41%) lived in neighborhoods of highest ADI compared to White children (16%). Black race was associated with lower LLDAS achievement (adjusted odds ratio 0.56, 95% confidence interval [CI] 0.38–0.82) and higher disease activity (adjusted β 0.94, 95% CI 0.11–1.78). The highest ADI was not associated with lower LLDAS achievement on adjustment for renal disease and insurance. However, renal disease was found to be a significant mediator (P = 0.04) of the association between ADI and prednisone exposure. Conclusions: Children with cSLE who identified as Black are less likely to achieve LLDAS and have a higher disease activity. Living in areas of higher ADI may relate to renal disease and subsequent prednisone exposure. Strategies to address root causes will be important to design interventions mitigating cSLE racial disparities.
AB - Objective: Differential disease control may contribute to racial disparities in outcomes of childhood-onset systemic lupus erythematosus (cSLE). We evaluated associations of race and individual- or neighborhood-level social determinants of health (SDoH) with achievement of low lupus disease activity state (LLDAS), a clinically relevant treatment target. Methods: In this cSLE cohort study using the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, the primary exposure was self-reported race and ethnicity, and collected SDoH included insurance status and area deprivation index (ADI). Outcomes included LLDAS, disease activity, and time-averaged prednisone exposure. Associations among race and ethnicity, SDoH, and disease activity were estimated with multivariable regression models, adjusting for disease-related and demographic factors. Results: Among 540 children with cSLE, 27% identified as Black, 25% identified as White, 23% identified as Latino/a, 11% identified as Asian, 9% identified as more than one race, and 5% identified as other. More Black children (41%) lived in neighborhoods of highest ADI compared to White children (16%). Black race was associated with lower LLDAS achievement (adjusted odds ratio 0.56, 95% confidence interval [CI] 0.38–0.82) and higher disease activity (adjusted β 0.94, 95% CI 0.11–1.78). The highest ADI was not associated with lower LLDAS achievement on adjustment for renal disease and insurance. However, renal disease was found to be a significant mediator (P = 0.04) of the association between ADI and prednisone exposure. Conclusions: Children with cSLE who identified as Black are less likely to achieve LLDAS and have a higher disease activity. Living in areas of higher ADI may relate to renal disease and subsequent prednisone exposure. Strategies to address root causes will be important to design interventions mitigating cSLE racial disparities.
UR - http://www.scopus.com/inward/record.url?scp=85206931820&partnerID=8YFLogxK
U2 - 10.1002/acr.25443
DO - 10.1002/acr.25443
M3 - Article
C2 - 39344152
AN - SCOPUS:85206931820
SN - 2151-464X
VL - 77
SP - 38
EP - 49
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 1
ER -