Faden Daniella Forman, Xie Lillian, Stone Caroline, Lopes Almeida Gomes Lais, Le Todd, Ezeh Nnenna, Buckingham William R, Kind Amy, Vleugels Ruth Ann, Werth Victoria P, Arkin Lisa, Shaw Katharina S
Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Dermatol. 2024 Sep 1;160(9):984-988. doi: 10.1001/jamadermatol.2024.2355.
The association of area deprivation with outcomes in discoid lupus erythematosus (DLE) remains poorly understood.
To determine the association between US Census block measures of deprivation and disease severity in adult patients with DLE.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 154 patients with DLE seen between January 1, 2007, and January 1, 2024, at a single-center referral-based specialty rheumatologic-dermatology clinic in Philadelphia, Pennsylvania. Patients were aged 18 to 73 years and were enrolled in the University of Pennsylvania's Cutaneous Lupus Erythematosus Database study. Data were analyzed between January 1, 2024, and May 8, 2024.
Residence in a highly disadvantaged area as geocoded by a state area deprivation index (ADI).
The main outcome was DLE disease severity as codified by the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) damage and activity scores.
A total of 154 adult patients with DLE (128 women [83%] and 26 men [17%]; mean [SD] age, 43 [13] years; 6 [4%] Asian individuals, 98 [64%] Black individuals, 2 [1%] Hispanic individuals, 46 [30%] White individuals, and 2 individuals [1%] with other race or ethnicity; 78 [51%] with an ADI >5; 43 who currently smoked [28%];and 56 [36%] with concurrent systemic lupus erythematosus) were included in the analysis. By multivariable logistic regression, residence within communities with an ADI greater than 5 was associated with nearly 4-fold greater odds of moderate to severe damage (odds ratio [OR], 3.90; 95% CI, 1.27-12.69] and activity (OR, 3.31; 95% CI, 1.27-9.44). Concurrent cigarette smoking was similarly associated with greater odds of moderate to severe damage (OR, 3.15; 95% CI, 1.09-10.29). After controlling for ADI and other confounders, race was not significantly associated with DLE disease severity.
The results of this cross-sectional study suggest that geospatial disadvantage is associated with DLE disease severity independent of race. This invites a paradigm shift that considers the social context within which racial disparities are observed, highlighting the potential for geographically targeted interventions and policy changes to improve patient outcomes in DLE.
盘状红斑狼疮（DLE）患者的地区贫困状况与疾病结局之间的关联仍未得到充分理解。
确定美国人口普查街区贫困指标与成年DLE患者疾病严重程度之间的关联。
设计、背景和参与者：这项横断面研究纳入了2007年1月1日至2024年1月1日期间在宾夕法尼亚州费城一家基于转诊的单中心专科风湿-皮肤科诊所就诊的154例DLE患者。患者年龄在18至73岁之间，参加了宾夕法尼亚大学的皮肤红斑狼疮数据库研究。数据于2024年1月1日至2024年5月8日进行分析。
居住在由州地区贫困指数（ADI）地理编码的高度贫困地区。
主要结局是根据经过验证的皮肤红斑狼疮疾病面积和严重程度指数（CLASI）损伤和活动评分编码的DLE疾病严重程度。
总共154例成年DLE患者（128名女性[83%]和26名男性[17%]；平均[标准差]年龄为43[13]岁；6名[4%]亚洲人，98名[64%]黑人，2名[1%]西班牙裔，46名[30%]白人，2名[1%]其他种族或族裔；78名[51%]的ADI>5；43名目前吸烟[28%]；56名[36%]并发系统性红斑狼疮）纳入分析。通过多变量逻辑回归分析，居住在ADI大于5的社区与中度至重度损伤（优势比[OR]，3.90；95%置信区间[CI]，1.27-12.69）和活动（OR，3.31；95%CI，1.27-9.44）的几率高出近4倍相关。同时吸烟同样与中度至重度损伤的几率增加相关（OR，3.15；95%CI，1.09-10.29）。在控制了ADI和其他混杂因素后，种族与DLE疾病严重程度无显著关联。
这项横断面研究结果表明，地理空间劣势与DLE疾病严重程度相关，且独立于种族。这促使范式转变，考虑到观察到种族差异的社会背景，突出了地理靶向干预和政策改变对改善DLE患者结局的潜力。
