Lotstein D S, Ward M M, Bush T M, Lambert R E, van Vollenhoven R, Neuwelt C M
Department of Medicine, Stanford University School of Medicine, California, USA.
J Rheumatol. 1998 Sep;25(9):1720-9.
Health outcomes of patients with chronic illnesses are commonly worse in people of lower socioeconomic status (SES). We investigated psychosocial factors that may mediate the relationship between SES and measures of morbidity in women with systemic lupus erythematosus (SLE).
We collected information on SES, psychosocial factors, and health status in a cross sectional survey of 100 women with SLE. SES was rated using the Hollingshead Two-Factor Index, a weighted average of years of formal education and occupational prestige (higher Hollingshead Index=lower SES). Health status measures included the Health Assessment Questionnaire Disability Index (HAQ), the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR), the Systemic Lupus Activity Measure (SLAM), and the SLE Disease Activity Index (SLEDAI). Potential mediators consisted of 18 environmental, medical care, social, psychological, and behavioral factors.
Patients with higher Hollingshead Indexes (lower SES) had more functional disability as measured by the HAQ (r=0.22: p=0.03) and more cumulative organ damage as measured by the SLICC/ACR Damage Index (r = 0.19; p=0.06). SES was not related to either the SLAM or SLEDAI. Significant univariate associations were present between the Hollingshead Index and 10 potential mediating variables: household crowding, insurance status, organizational barriers to medical care, depression, health locus of control by powerful others, SLE knowledge, social support, marital status, body mass index, and regular alcohol use. However, in multiple linear regression analyses, only 3 of these variables modified the relationship between Hollingshead Index and the HAQ: more severe depression scores, higher body mass index, and more restricted access to medical care. More severe depression and greater locus of control by powerful others tended to mediate the relationship between low SES and greater organ damage.
SES is related to morbidity in women with SLE. There are identifiable and potentially modifiable mediators of this relationship.
社会经济地位（SES）较低人群中慢性病患者的健康结局通常更差。我们调查了可能介导SES与系统性红斑狼疮（SLE）女性患者发病率指标之间关系的心理社会因素。
我们在一项对100名SLE女性患者的横断面调查中收集了SES、心理社会因素和健康状况的信息。SES使用霍林斯黑德双因素指数进行评分，该指数是正规教育年限和职业声望的加权平均值（霍林斯黑德指数越高=SES越低）。健康状况指标包括健康评估问卷残疾指数（HAQ）、系统性红斑狼疮国际协作临床/美国风湿病学会损伤指数（SLICC/ACR）、系统性狼疮活动度量表（SLAM）和SLE疾病活动指数（SLEDAI）。潜在中介因素包括18个环境、医疗保健、社会、心理和行为因素。
霍林斯黑德指数较高（SES较低）的患者，根据HAQ测量的功能残疾更多（r = 0.22；p = 0.03），根据SLICC/ACR损伤指数测量的累积器官损伤更多（r = 0.19；p = 0.06）。SES与SLAM或SLEDAI均无关联。霍林斯黑德指数与10个潜在中介变量之间存在显著单变量关联：家庭拥挤、保险状况、医疗保健的组织障碍、抑郁、他人强大控制下的健康控制点、SLE知识、社会支持、婚姻状况、体重指数和定期饮酒。然而，在多元线性回归分析中，这些变量中只有3个改变了霍林斯黑德指数与HAQ之间的关系：更严重的抑郁评分、更高的体重指数以及更受限的医疗保健获取途径。更严重的抑郁和他人更强大控制下的更大控制点倾向于介导低SES与更大器官损伤之间的关系。
SES与SLE女性患者的发病率相关。这种关系存在可识别且可能可改变的中介因素。
