Soulsby William Daniel, Olveda Rebecca, He Jie, Berbert Laura, Weller Edie, Barbour Kamil E, Greenlund Kurt J, Schanberg Laura E, von Scheven Emily, Hersh Aimee, Son Mary Beth F, Chang Joyce, Knight Andrea
University of California, San Francisco.
Palo Alto Medical Foundation Medical Group, Palo Alto, California.
Arthritis Care Res (Hoboken). 2025 Jan;77(1):38-49. doi: 10.1002/acr.25443. Epub 2024 Oct 22.
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.
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.
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.
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.
疾病控制差异可能导致儿童期系统性红斑狼疮（cSLE）结局存在种族差异。我们评估了种族以及个体或社区层面的健康社会决定因素（SDoH）与低狼疮疾病活动状态（LLDAS）达成情况之间的关联，LLDAS是一个具有临床相关性的治疗目标。
在这项使用儿童关节炎和风湿病研究联盟（CARRA）注册库的cSLE队列研究中，主要暴露因素是自我报告的种族和族裔，收集的SDoH包括保险状况和地区贫困指数（ADI）。结局包括LLDAS、疾病活动度和平均泼尼松暴露时间。采用多变量回归模型估计种族和族裔、SDoH与疾病活动度之间的关联，并对疾病相关因素和人口统计学因素进行校正。
在540例cSLE患儿中，27%为黑人，25%为白人，23%为拉丁裔，11%为亚洲人，9%为多种族，5%为其他种族。与白人儿童（16%）相比，更多黑人儿童（41%）生活在ADI最高的社区。黑人种族与较低的LLDAS达成率相关（校正比值比0.56，95%置信区间[CI]0.38 - 0.82）以及较高的疾病活动度（校正β值0.94，95%CI 0.11 - 1.78）。在对肾脏疾病和保险进行校正后，最高的ADI与较低的LLDAS达成率无关。然而，发现肾脏疾病是ADI与泼尼松暴露之间关联的一个显著中介因素（P = 0.04）。
自我认定为黑人的cSLE患儿达到LLDAS的可能性较小且疾病活动度较高。生活在ADI较高的地区可能与肾脏疾病及随后的泼尼松暴露有关。解决根本原因的策略对于设计减轻cSLE种族差异的干预措施至关重要。
