Abstract
Objective
To determine if neighborhood socioeconomic status (SES) is independently related to physical and mental health outcomes in systemic lupus erythematosus (SLE).
Methods
Data derived from the first 3 waves of the Lupus Outcomes Study, a telephone survey of 957 patients with confirmed SLE diagnoses, recruited from clinical and non-clinical sources. Residential addresses were geocoded to U.S. Census block groups. Outcome measures included the Systemic Lupus Activity Questionnaire (SLAQ) score, a self-reported assessment of SLE symptoms; the Medical Outcomes Study Short Form-36 Health Survey physical functioning score; and Center for Epidemiologic Studies-Depression (CES-D) score of ≥ 19 points. Multivariate analyses adjusted for race/ethnicity and other demographic and health-related covariates.
Results
After adjustment, lower individual SES, measured by education, household income, or poverty status, was associated with all outcomes. In models that did not include individual SES, low neighborhood SES (> 30% of residents in poverty) was also associated with poor outcomes. After adjustment for individual SES, demographic, and health-related covariates, only CES-D ≥ 19 remained associated with neighborhood SES: 47% [95% confidence interval (CI) 38–56%] versus 35% (95% CI 32–37%).
Conclusion
Individual SES is associated with physical and mental health outcomes in persons with SLE. Low neighborhood SES contributes independently to high levels of depressive symptoms. Future research should focus on mechanisms underlying these differences. (First Release July 15 2008; J Rheumatol 2008;35:1782–8)
Key Indexing Terms:Footnotes
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L. Trupin, MPH, Academic Coordinator; M.C. Tonner, MPH, Data Analyst; J. Yazdany, MD, MPH, Assistant Professor of Medicine; L.J. Julian, PhD, Assistant Professor of Medicine; L.A. Criswell, MD, MPH, Professor of Medicine, Department of Medicine (Rosalind Russell Medical Research Center for Arthritis, Division of Rheumatology); P.P. Katz, PhD, Professor of Medicine and Health Policy; E. Yelin, PhD, Professor of Medicine and Health Policy, Department of Medicine and Institute for Health Policy Studies, University of California, San Francisco.
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Supported with grants from the Arthritis Foundation, AHRQ/NIAMS (R01 HS12893-02), NIAMS (P60 AR053308-01, R01 AR44804, K24 AR02175), and the Kirkland Scholar Award. These studies were performed in part in the General Clinical Research Center, Moffitt Hospital, University of California, San Francisco, with funds provided by the National Center for Research Resources, 5 M01 RR-00079, U.S. Public Health Service.
- Accepted for publication April 8, 2008.