Sociodemographic Disparities in SLE Incidence: Behavioral and Psychosocial Factors

 描述(由申请人提供)：在这项研究系统性红斑狼疮(SLE)(包括狼疮性肾炎和终末期肾脏疾病)结果的社会人口学差异的非常成功的拨款的竞争性更新中，我们将把注意力转向SLE发病率中存在的令人震惊和无法解释的社会人口学差异。大多数SLE患者是女性，黑人的发病率比白人高得多，结果比白人差得多。此外，在参加联邦医疗补助(Medicaid)的人口中，我们发现生活在贫困地区的人中SLE有所增加。我们将调查三类可能导致黑人和低社会经济地位女性系统性红斑狼疮发病率上升的潜在可改变的社会和行为因素：1.饮食因素和模式，特别是鱼类(富含抗炎omega-3脂肪酸)，以及以快餐、高饱和脂肪、加工肉类、土豆和含糖软饮料为特征的西式“促炎”饮食模式；2.肥胖，导致全身炎症；3.心理社会因素，包括抑郁症状、焦虑和遭受虐待。我们假设，这些暴露与SLE自身免疫生物标志物的升高以及SLE的发生有关。我们将利用系统性红斑狼疮之前前瞻性跟踪的最大女性集合、护士健康研究和黑人女性健康研究队列，以及关于饮食、生活方式、心理社会因素和银行血样的丰富数据。凭借出色的统计能力，我们将研究这些在不同时期的暴露是否以及如何改变一系列社会经济背景的白人和黑人女性的SLE风险。我们的多学科调查团队涵盖营养流行病学、社会和行为流行病学、生物统计学和风湿学，将采用先进和创新的流行病学概念和分析。拟议的分析将提供目前缺乏的关于观察到的SLE社会人口差异的潜在流行病学解释的信息。这些发现将具有重要的公共卫生和临床影响，直接为旨在预防和减少系统性红斑狼疮差异的生活方式干预提供信息。

 DESCRIPTION (provided by applicant): In this competitive renewal of a highly successful grant investigating sociodemographic disparities in outcomes from systemic lupus erythematosus (SLE), including lupus nephritis and end-stage renal disease, we will turn our attention to the alarming and unexplained sociodemographic disparities that exist in SLE incidence. Most SLE patients are women and blacks have much higher incidence and poorer outcomes than whites. Moreover, within the population enrolled in Medicaid, the Federal-state insurance for low income Americans, we have shown increased SLE among those living in poorer areas. We will investigate three classes of potentially modifiable social and behavioral factors that may contribute to increased SLE incidence among black and low socioeconomic status women: 1. dietary factors and patterns, specifically fish (rich in anti-inflammatory omega-3 fatty acids), and the Western "pro-inflammatory" dietary pattern, characterized by fast food, high saturated fat, processed meats, potatoes, and sugar-sweetened soft drinks; 2. obesity, which induces systemic inflammation, and; 3. psychosocial factors including depressive symptoms, anxiety and exposure to abuse. We hypothesize that these exposures are associated with elevated biomarkers of SLE autoimmunity, as well as with incident SLE. We will utilize the largest collection of women followed prospectively prior to SLE, the Nurses' Health Study and the Black Women's Health Study cohorts, with rich data on dietary, lifestyle, psychosocial factors, and banked blood samples. With excellent statistical power, we will examine whether and how these exposures at different time periods of life may alter SLE risk among white and black women of a range of socioeconomic backgrounds. Our multidisciplinary investigative team spanning nutritional epidemiology, social and behavioral epidemiology, biostatistics, and rheumatology will employ advanced and innovative epidemiologic concepts and analyses. The proposed analyses will provide currently lacking information concerning potential epidemiologic explanations for observed sociodemographic disparities in SLE. The findings will have important public health and clinical implications, directly informing lifestyle interventions aimed at preventing and reducing disparities in SLE.