THE RELATIONSHIP OF SOCIOECONOMIC-STATUS, RACE, AND MODIFIABLE RISK-FACTORS TO OUTCOMES IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS

Objective. To study the relationship of race, socioeconomic status (SE S), clinical factors, and psychosocial factors to outcomes in patients with systemic lupus erythematosus (SLE). Methods. A retrospective coh ort was assembled, comprising 200 patients with SLE from 5 centers, Th is cohort was balanced in terms of race and SES, Patients provided inf ormation on socioeconomic factors, access to health care, nutrition, s elf-efficacy for disease management, health locus of control, social s upport, compliance, knowledge about SLE, and satisfaction with medical care, Outcome measures included disease activity (measured by the Sys temic Lupus Activity Measure), damage (measured by the SLICC/ACR damag e index), and health status (measured by the SF-36). Results. In multi variate models that were controlled for race, SES, center, psychosocia l factors, and clinical factors, lower self-efficacy for disease manag ement (P less than or equal to 0.0001), less social support (P < 0.005 ), and younger age at diagnosis (P < 0.007) were associated with great er disease activity, Older age at diagnosis (P less than or equal to 0 .0001), longer duration of SLE (P less than or equal to 0.0001), poor nutrition (P < 0.002), and higher disease activity at diagnosis (P < 0 .007) were associated with more damage, Lower self-efficacy for diseas e management was associated with worse physical function (P less than or equal to 0.0001) and worse mental health status (P less than or equ al to 0.0001). Conclusion. Disease activity and health status were mos t strongly associated with potentially modifiable psychosocial factors such as self-efficacy for disease management, Cumulative organ damage was most highly associated with clinical factors such as age and dura tion of disease, None of the outcomes measured were associated with ra ce, These results suggest that education and counseling, coordinated w ith medical care, might improve outcomes in patients with SLE.