摘要
目的：幼年型系统性红斑狼疮（JSLE）的发病率因种族/民族而异，环境、遗传和社会因素与疾病的严重程度和预后有关。然而，人们对健康的社会决定因素（SDoH）在疾病表现中的作用还不甚了解。我们假设，在一个拥有大型、多样化集水区的城市中心，SDoH 会影响诊断时 JSLE 的严重程度：我们对德克萨斯州休斯顿德克萨斯儿童医院在 2018 年 1 月 1 日至 2022 年 5 月 31 日期间新诊断为 JSLE 的儿童进行了机构审查委员会批准的病历审查。我们收集了人口统计学数据、临床严重程度指标以及 SDoH 变量，如地区贫困指数 (ADI)、保险状况、污染负担和食物可及性。比较 SDoH 与 JSLE 严重程度的统计分析包括 Kruskal-Wallis 检验、费雪精确检验以及单变量和多变量回归：136名患者的平均诊断年龄为13.4岁，其中82.4%为女性，52.9%为西班牙裔，25.7%为非西班牙裔（NH）黑人。三分之一的患者没有记录在案的初级保健提供者，三分之一的患者选择非英语语言。我们发现新罕布什尔州黑人患者的临床严重程度更差，系统性红斑狼疮疾病活动指数最高，中枢神经系统受累更多，需要接受环磷酰胺治疗。无保险和有公共保险的患者在确诊时更有可能使用住院资源，他们居住的社区污染程度更高，ADI 也更高。西班牙裔患者所居住的社区ADI评分较高，超市购物机会有限：结论：在大城市集水区的 JSLE 患儿中，我们观察到非可改变因素（种族/民族）和可改变因素（保险状况、获得护理的机会、食物的可获得性）与发病时的疾病严重程度有显著关联。Objective: The prevalence of juvenile-onset systemic lupus erythematosus (JSLE) differs by race/ethnicity with environmental, genetic, and social factors implicated in disease severity and outcomes. Yet, the role of social determinants of health (SDoH) in disease presentation is not well understood. We hypothesized that in an urban center with a large, diverse catchment area, SDoH influence the severity of JSLE at diagnosis.
Methods: We completed an institutional review board-approved medical record review of children newly diagnosed with JSLE between January 1, 2018, and May 31, 2022, at Texas Children's Hospital in Houston, TX. We collected demographic data, clinical severity measures, and SDoH variables such as Area Deprivation Index (ADI), insurance status, pollution burden, and food accessibility. Statistical analysis to compare SDoH with JSLE severity included Kruskal-Wallis test, Fisher exact test, and univariable and multivariable regression.
Results: Mean diagnosis age for 136 patients was 13.4 years, with 82.4% female, 52.9% Hispanic, and 25.7% non-Hispanic (NH) Black. One-third of patients did not have a documented primary care provider, and one-third preferred non-English language. We found NH Black patients had worse clinical severity measures, with highest Systemic Lupus Erythematosus Disease Activity Index and more central nervous system involvement and cyclophosphamide therapy. Uninsured and publicly insured patients were more likely to use inpatient resources at diagnosis and live in neighborhoods with higher pollution levels and higher ADI. Hispanic patients reside in communities with higher ADI scores and limited access to supermarkets.
Conclusion: In children with JSLE from a large urban catchment area, we observed significant association of nonmodifiable (race/ethnicity) and modifiable (insurance status, access to care, food accessibility) factors on disease severity at presentation.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
