THE INDEPENDENCE AND STABILITY OF SOCIOECONOMIC PREDICTORS OF MORBIDITY IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Objective. We studied the relationship between systemic lupus erythema tosus (SLE) morbidity and socioeconomic status (SES) at 5 centers. Met hods. Ninety-nine patients who met American College of Rheumatology cr iteria for SLE were randomly sampled at each center, balancing by race and insurance status. Subjects were interviewed for current and past SES factors, such as insurance, occupation, employment, education, and income. SLE disease activity was measured by the SLE Activity Measure (SLAM). Result. Higher education, private insurance/ Medicare, and hi gher income were associated with less disease activity at diagnosis. c ontrolling for SES, race, and center, the best predictors of less acti ve disease at diagnosis were private insurance/Medicare (P = 0.002) an d higher education (P = 0.007). From the time of diagnosis to the stud y visit (mean 3.5 years), insurance, income, and employment status cha nged for a significant number of subjects (37%, 16%, and 21%, respecti vely). Conclusion. Private insurance or Medicare and higher education are associated with less active disease at diagnosis of SLE. Health in surance, income, and employment status are unstable measures of socioe conomic status and may explain the variability in conclusions of previ ous studies on the role of SES in SLE.