Geography & Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
Geography & Environmental Management, University of Waterloo, Waterloo, Ontario, Canada.
Lupus Sci Med. 2024 Jul 24;11(2):e001155. doi: 10.1136/lupus-2024-001155.
Systemic lupus erythematosus (SLE) is a chronic autoimmune condition with significant physical, mental, psychosocial and economic impacts. A main driver of SLE morbidity and mortality is cardiovascular disease (CVD). Both SLE and CVD exhibit disparities related to gender, race and other social dimensions linked with biological outcomes and health trajectories. However, the biospsychosocial dimensions of CVD in SLE populations remain poorly understood. The objective of this study was to systematically investigate the existing literature around known social factors influencing the development of CVD in SLE.
A scoping review protocol was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews guidelines. The search strategy encompassed three main concepts: SLE, CVD and social factors. Four databases were searched (PubMed, SCOPUS, PsychINFO and CINAHL). 682 studies were identified for screening. Articles were screened in two phases (title/abstract and full text) to determine whether they fulfilled the selection criteria.
Nine studies were included after screening. All were conducted in the USA between 2009 and 2017. Six studies (67%) were cross-sectional and three (33%) were longitudinal. Most employed SLE cohorts (n=7, 78%) and two drew from healthcare databases (n=2; 22%). We identified five main themes encompassing social factors: socioeconomic status and education (n=5; 56%), race and/or ethnicity (n=7; 78%), mental health (n=2; 22%), gender (n=3; 33%) and healthcare quality and/or insurance (n=2; 22%). Overall, low income, fewer years of education, black race and/or ethnicity, depression, male gender, lack of insurance and healthcare fragmentation were all associated with CVD risk factors and outcomes in SLE.
While several social factors contribute to CVD in SLE populations, considerable gaps remain as many social determinants remain un(der)explored. There is rich opportunity to integrate social theory, advance conceptualisations of race and/or ethnicity and gender, expand investigations of mental health and explore novel geographical contexts. In healthcare policy and practice, identified social factors should be considered for SLE populations during decision-making and treatment, and education resources should be targeted for these groups.
系统性红斑狼疮（SLE）是一种慢性自身免疫性疾病，对身体、心理、心理社会和经济都有重大影响。SLE 发病率和死亡率的一个主要驱动因素是心血管疾病（CVD）。SLE 和 CVD 都存在与性别、种族和其他与生物结果和健康轨迹相关的社会维度有关的差异。然而，SLE 人群中 CVD 的生物心理社会维度仍知之甚少。本研究的目的是系统地调查现有文献中与影响 SLE 患者 CVD 发展的已知社会因素。
根据系统评价和荟萃分析扩展的首选报告项目制定了范围综述方案。搜索策略涵盖了三个主要概念：SLE、CVD 和社会因素。共搜索了四个数据库（PubMed、SCOPUS、PsychINFO 和 CINAHL）。对 682 项研究进行了筛选。文章在两个阶段（标题/摘要和全文）进行筛选，以确定是否符合选择标准。
筛选后有 9 项研究纳入。所有研究均于 2009 年至 2017 年在美国进行。6 项研究（67%）为横断面研究，3 项（33%）为纵向研究。大多数研究采用 SLE 队列（n=7，78%），2 项研究来自医疗保健数据库（n=2，22%）。我们确定了涵盖社会因素的五个主要主题：社会经济地位和教育（n=5，56%）、种族和/或民族（n=7，78%）、心理健康（n=2，22%）、性别（n=3，33%）和医疗保健质量和/或保险（n=2，22%）。总体而言，低收入、受教育年限少、黑种人/黑人种族和/或民族、抑郁、男性、缺乏保险和医疗保健碎片化均与 SLE 患者的 CVD 危险因素和结局相关。
尽管有几个社会因素会导致 SLE 人群发生 CVD，但仍有相当大的差距，因为许多社会决定因素仍未得到探索。有丰富的机会将社会理论、种族和/或民族和性别概念化、扩大心理健康调查以及探索新的地理背景纳入研究。在医疗保健政策和实践中，应在决策和治疗过程中考虑到 SLE 人群中的这些社会因素，并为这些群体提供教育资源。
