Q: Why are African-American women three times more likely to get lupus than white women, and why do African-American women tend to develop lupus at a younger age and have more severe symptoms than white women?
- Joleen, Sauk Rapids
A: We don’t fully know the answers to these questions yet, but researchers are working hard to discover them. They believe that the answers will go beyond race, and they hope they will reveal modifiable risk factors; that is, factors that patients and/or their caregivers could potentially take action to change. These could be keys to reducing such disparities.
One likely culprit is genetics. There are many genetic factors that can put individuals at a greater risk of developing lupus. It’s possible that some genetic risk factors are specific to African-Americans and might put individuals at risk for a more severe form of lupus. However, genetic factors can’t completely explain the increase in lupus incidence and severity in African-Americans. And since you can’t take action to change your genes, these genetic factors don’t make easy targets for interventions aimed at reducing disparities in lupus.
Studies have shown that socioeconomic factors, such as income, education, medical insurance, and access to quality healthcare are correlated with lupus activity and severity. Sadly, race and socioeconomic factors often overlap, making it extremely difficult to identify what truly causes lupus to be more severe in African-Americans. Fortunately, researchers have recently developed tools to help adjust for the overlap. Here are a few of their conclusions:
(1) Lower socioeconomic status, not race, is a predictor of diminished survival in lupus patients. Researchers made this conclusion because after they adjusted for socioeconomic factors, there was no significant difference in mortality between African-American and Caucasian lupus patients.
(2) The increased frequency of renal disease in African-American patients seems to be due more to genetic factors than socioeconomic factors. This is based on the observation that African-American patients were more likely to have renal disease even after they adjusted for socioeconomic factors.
(3) Overall lupus severity and survival are influenced more by socioeconomic factors like poverty, education, and medical insurance. So, there may indeed be modifiable risk factors that could be targeted to improve long-term outcomes in lupus. Some interventions that have already shown some success were aimed at increasing patient participation in their clinic visits and boosting social support.