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Contribution of Socioeconomic Status to Racial/Ethnic Disparities in Adverse Pregnancy Outcomes Among Women With Systemic Lupus Erythematosus
Author(s) -
Kaplowitz Elianna T.,
Ferguson Sancia,
Guerra Marta,
Laskin Carl A.,
Buyon Jill P.,
Petri Michelle,
Lockshin Michael D.,
Sammaritano Lisa R.,
Branch D. Ware,
Merrill Joan T.,
Katz Patricia,
Salmon Jane E.
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23263
Subject(s) - medicine , odds ratio , lupus erythematosus , confidence interval , pacific islanders , socioeconomic status , pregnancy , logistic regression , ethnic group , demography , obstetrics , immunology , population , antibody , environmental health , sociology , biology , anthropology , genetics
Objective We examined rates of adverse pregnancy outcomes ( APO ) by race/ethnicity among women with systemic lupus erythematosus ( SLE ), with and without antiphospholipid antibodies ( aPL ), and whether socioeconomic status ( SES ) accounted for differences. Methods Data were from the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study, a multicenter study that enrolled 346 patients with SLE and 62 patients with SLE and aPL (50% white, 20% African American, 17% Hispanic, 12% Asian/Pacific Islander). Measures of SES were educational attainment, median community income, and community education. Logistic regression analyses were conducted to determine odds of APO for each racial/ethnic group, controlling first for age and clinical variables, and then for SES . Results The frequency of APO in white women with SLE , with and without aPL , was 29% and 11%, respectively. For African American and Hispanic women it was approximately 2‐fold greater. In African American women with SLE alone, adjustment for clinical variables attenuated the odds ratio ( OR ) from 2.7 (95% confidence interval [95% CI ] 1.3–5.5) to 2.3 (95% CI 1.1–5.1), and after additional adjustment for SES , there were no longer significant differences in APO compared to whites. In contrast, in SLE patients with aPL , whites, African Americans, and Hispanics had markedly higher risks of APO compared to white SLE patients without aPL ( OR 3.5 [95% CI 1.4–7.7], OR 12.4 [95% CI 1.9–79.8], and OR 10.4 [95% CI 2.5–42.4], respectively), which were not accounted for by clinical or SES covariates. Conclusion This finding suggests that for African American women with SLE without aPL , SES factors are key contributors to disparities in APO , despite monthly care from experts, whereas other factors contribute to disparities in SLE with aPL .