Unraveling Race, Socioeconomic Factors, and Geographical Context in the Heterogeneity of Lupus Mortality in the United States
Unraveling Race, Socioeconomic Factors, and Geographical Context in the Heterogeneity of Lupus Mortality in the United States
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DOI：
10.1002/acr2.1024
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发表时间：
2019-05-01
影响因子：
3.4
通讯作者：
Simard, Julia F.
中科院分区：
文献类型：
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作者：
Falasinnu, Titilola;Chaichian, Yashaar;Simard, Julia F.
Objective.系统性红斑狼疮（SLE）是一种慢性自身免疫性疾病，不成比例地影响妇女和种族/少数民族。我们研究了SLE相关死亡率随时间的变化，以评估种族的影响是否减弱，同时考虑社会经济地位（SES）和地理环境。这项研究使用美国人口的种族-地理组合（被称为“八个美洲”）来检验社会环境是否会削弱SLE相关死亡率的种族差异。“这个框架共同表征了种族，社会经济地位和地理位置与美国健康差距的关系。使用国家生命统计和美国人口普查数据，我们估计死亡率参数的八个美国。我们确定了24773例SLE死亡（2003-2014）。在三个种族地理环境中，黑人的平均年死亡率最高：平均收入黑人，南方低收入黑人和高风险城市黑人（每百万人口死亡14至15人），生活在平均收入环境中的非黑人最低（每百万人口死亡3至4人）。黑人和亚洲人的死亡年龄最低（相似于47.5岁），低收入农村白人的死亡年龄最高（相似于64.8岁）。与白人有着相同社会和地理背景的黑人更有可能英年早逝。虽然黑人居住在三个截然不同的背景下，SLE相关的死亡率参数并没有不同的社会和弱势黑人。这些研究结果表明，种族可能超越SES和地理参数作为SLE相关死亡率的关键决定因素。
Objective. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease disproportionately affecting women and racial/ethnic minorities. We examined SLE-related mortality over time to assess whether the impact of race is attenuated when social economic status (SES) and geographic context are also considered.Methods. This study examined whether social environment attenuates racial disparities in SLE-related mortality using race-geographical combinations of the US population known as the "Eight Americas." This framework jointly characterizes race, SES, and geographical location in relation to health disparities in the United States. Using National Vital Statistics and US Census data, we estimated mortality parameters for each of the Eight Americas.Results. We identified 24 773 SLE deaths (2003-2014). Average annual mortality rates were highest among blacks in three race-geographical contexts: average-income blacks, southern low-income blacks, and high-risk urban blacks (14 to 15 deaths per million population) and lowest among nonblacks living in average-income settings (3 to 4 deaths per million population). Age at death was lowest (similar to 47.5 years) for blacks and Asians and highest among low-income rural whites (similar to 64.8 years).Conclusion. Blacks sharing the same social and geographical contexts as whites were disproportionately more likely to die young. Although blacks inhabited three vastly different contexts, SLE-related mortality parameters did not vary among socially advantaged and disadvantaged blacks. These findings suggest that race may transcend SES and geographical parameters as a key determinant of SLE-related mortality.