Black and Hispanic Americans with systemic lupus erythematosus (SLE) who are diagnosed with COVID-19 more often tend to have more severe cases than their peers in other demographic groups, new analysis finds published in Arthritis Care & Research.
Previous literature has suggested that race, ethnicity, and socioeconomic status affect COVID-19 outcomes across the entire US population, but the new report would be the first to examine COVID disparities -19 specifically in people with SLE.
The authors said previous reports indicated 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 exposure and health care, rather than genetics or other biological factors, explain the disparate results,” the authors said.
Similarly, previous data shows that non-white people with SLE are more likely to have severe manifestations of SLE.
“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 with COVID-19 and to see if disparities seen in other settings carry over to this group of patients, the researchers analyzed data from the COVID-19 Global Rheumatology Alliance Registry of March 2020 to August 2021. They then compared demographic factors and SLE disease characteristics to COVID-19 outcomes to see if race and ethnicity affected COVID-19 severity.
There were 523 patients with SLE and COVID-19 included in the study, of which 90.7% were female. In 74.6% of cases, a diagnosis of COVID-19 did not result in hospitalization. However, of 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 than white patients with SLE (odds ratios, 2, 73 and 2.76, respectively). A subanalysis of unvaccinated patients and those with unknown vaccination status found similar results, the researchers said.
The observed disparities in COVID-19 outcomes have occurred despite other differences between racial and ethnic cohorts.
“White populations tended to be older than other groups, had fewer comorbidities, less frequent use of prednisone, and more frequent use of antimalarial monotherapies and biological and immunosuppressive treatments,” the investigators reported. “Nevertheless, black and Hispanic individuals performed worse than white individuals, even after adjusting for demographic, disease-specific characteristics, and comorbidities.”
The investigators said other research indicates that black and Hispanic people are more likely to live in areas with restricted access to healthcare facilities and are also more likely to be employed in jobs in which contact from person to person cannot be avoided. Both of these factors could have affected the results, they noted.
Their study has limitations, the authors added, and they include the fact that the data come from a single country – and therefore are not necessarily generalizable to other countries – and the possibility that other confounding factors may have been involved. could affect the data.
Still, they said, these data should spur more research and public health action.
“Achieving equitable health outcomes for socially disadvantaged SLE populations will likely require the implementation of public health measures that directly address social disparities and mitigate social disadvantage,” they said.
Ugarte-Gil MF, Alarcón GS, Seet AM, et al. Association between race/ethnicity and covid-19 outcomes in patients with systemic lupus erythematosus (SLE) in 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