Racial Disparities Correlate With COVID-19 Outcomes in People With SLE

Black and Hispanic Americans with systemic lupus erythematosus (SLE) who more often receive a COVID-19 diagnosis tend to have more severe cases than their peers in other demographic groups, according to a new analysis published in Arthritis Care & Research.

Previous literature has suggested that race, ethnicity, and socioeconomic status affect COVID-19 outcomes in the overall United States population, but the new report is believed to be the first to look at COVID-19 disparities specifically among people with SLE.

The authors said earlier reports indicate that Black and Hispanic patients in the United States were more likely to be exposed to COVID-19 and may have experienced delays in accessing medical care after infection.

“These data strongly suggest that differences in exposures and health care, rather than genetic or other biological factors, explain disparate outcomes,” the authors said.

Likewise, previous data show that non-White people with SLE are more likely to have severe SLE manifestations.

“However, studies also show that the relationship between race and ethnicity and disease outcomes is significantly confounded by social determinants of health in SLE,” they wrote.

To better understand the experiences of people with SLE who have COVID-19 and to see whether observed disparities in other contexts carry over into this patient group, the investigators analyzed data from the COVID-19 Global Rheumatology Alliance registry from March 2020 through August 2021. They then compared demographic factors and SLE disease characteristics to COVID-19 outcomes to see whether race and ethnicity affected COVID-19 severity.

There were 523 patients with SLE and COVID-19 included in the study, of whom 90.7% were female. In 74.6% of cases, a COVID-19 diagnosis did not result in hospitalization. However, among those who were hospitalized, 8.3% did not require oxygen, 13.3% were hospitalized and received oxygen, and 3.8% died.

Using a multivariate model, the authors found that Black and Hispanic patients with SLE were more likely to have severe COVID-19 outcomes compared with White patients with SLE (odds ratios, 2.73 and 2.76, respectively). A subanalysis of unvaccinated patients and those for whom vaccination status was unknown found similar results, the researchers said.

The observed disparities in COVID-19 outcomes occurred despite other differences between the racial and ethnic cohorts.

“White populations tended to be older than those in the other groups, had a lower number of comorbidities, used prednisone less frequently, and used more frequently antimalarials monotherapy and biologics and immunosuppressive drug combination therapy,” the investigators reported. “Nevertheless, Black and Hispanic individuals experienced poorer outcomes compared with White individuals, even after adjustment for demographic, disease-specific features, and comorbidities.”

The investigators said other research indicates that people who are Black and Hispanic are more likely to live in areas with restricted access to health care facilities and are also more likely to be employed in jobs in which person-to-person contact cannot be avoided. Both of those factors could have affected outcomes, they noted.

Their study has limitations, the authors added, and they include that the data come from a single country—and thus are not necessarily generalizable to other countries—and the potential that other confounders might have affected the data.

Still, they said, these data ought to spark more research and public health action.

“Achieving equitable health outcomes for socially disadvantaged SLE populations islikely to require the implementation of public health measures that directly address social disparities and mitigate social disadvantage,” they said.

Reference

Ugarte-Gil MF, Alarcón GS, Seet AM, et al. Association between race/ethnicity and covid-19 outcomes in systemic lupus erythematosus (SLE) patients from the united states: data from the COVID-19 Global Rheumatology Alliance. Arthritis Care Res (Hoboken). Published online October 14, 2022. doi:10.1002/acr.25039