Sociodemographic associations with early disease damage in patients with systemic lupus erythematosus

Objective. To examine the extent of organ damage among recently diagnosed patients with systemic lupus erythematosus (SLE), and to assess the association between sociodemographic variables and total damage and organ-specific damage scores. Methods. We evaluated damage in 132 patients with SLE (70 African Americans and 62 whites), 2-6 years (median 4 years) after diagnosis, using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. The associations between demographic characteristics and total damage and organ-specific damage measures were evaluated using logistic regression, adjusting for age, income, and ethnicity. Results. A total of 61% of patients scored >= 1 point on the damage index. Damage was most prevalent in the musculoskeletal (28%), skin (20%), neuropsychiatric (16%), and renal (12%) subscales. African American ethnicity and lower household income were independently associated with total damage scores (score >= 2: adjusted odds ratio [95% confidence interval] 6.0 [2.3-16.2] in African Americans and 2.7 [1.1-6.7] in patients with an annual household income <=$30,000). The odds of having skin damage, alopecia, or diabetes were at least 5 times higher in African Americans compared with whites, but ethnicity was not associated with renal damage (adjusted odds ratio 1.6, 95% confidence interval 0.40-6.1). Conclusion. Considerable damage is seen in SLE patients early in the disease course, and the pattern varies between ethnic groups. This analysis also highlights the importance of sociodemographic characteristics (particularly income) in predicting damage.