Biopsyochosocial Mechanisms of Lupus Progression in African American Women

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PROJECT SUMMARY Systemic lupus erythematous (SLE) is an inflammatory, autoimmune disease that disproportionally burdens African American women with more rapid disease progression and worse outcomes compared to their White counterparts. Increasing evidence suggests racial disparities in SLE progression are due in part to disproportionate exposure to psychosocial stress, as well as qualitatively unique racial minority stressors, which accelerate physiologic deterioration and may undermine shared inflammatory stress-response pathways involved in the pathogenesis of SLE. Routine experiences of psychosocial stress are common in the lives of African American women with SLE and can include stressors inherent with managing a chronic illness, in addition to those stemming from community disadvantage and poverty. African American women also face distinct forms of psychosocial stress, including experiences of racial discrimination and exposure to other race- related stressors. Despite existing evidence, mechanisms for racial disparities in SLE progression are poorly understood. To address these gaps in knowledge among African American women with SLE, this study aims to: (1) examine understudied dimensions of race-related psychosocial stress in relation to disease activity and organ damage; (2) examine the influence of area-level neighborhood characteristics and stressors on rates of SLE progression; and (3) identify trajectories in biomarkers of inflammation relevant to SLE and identify high- risk subgroups. Data for the proposed analyses are from the Black Women's Experiences Living with Lupus (BeWELL) Study, one of the largest and most comprehensive studies on the social epidemiology of SLE. The BeWELL Study represents a rigorous assessment of rich psychosocial factors, validated measures of disease outcomes, and objective inflammatory biomarkers among an innovative population-based sample of African American women with confirmed SLE (n=438) living in metropolitan Atlanta, Georgia. The proposed research will leverage the strengths of the BeWELL Study and yield insight into specific pathways that may contribute to the disproportionate rate of SLE progression experienced by African American women. We will investigate the role of novel race-related psychosocial stressors on SLE outcomes, including “secondhand” or vicarious exposure to racist incidents, subtle everyday slights or microaggressions, and anticipation of experiencing racial threats. Multilevel analyses will examine the influence of spatial factors, specifically socioeconomic disadvantage and racial residential segregation on SLE outcomes. Trajectories in inflammation will be identified and explored in relation to sociodemographic, mental and physical health factors. Longitudinal methodological approaches will be utilized to help support causal inference. Training activities throughout the proposed fellowship will develop skill sets and enhance knowledge needed to conduct the intended analyses and prepare for a career in research. Various opportunities for professional development and mentorship from a diverse team of scholars will facilitate this goal.