Social determinants of health and disparities across the Patient pathway in Systemic Lupus Erythematosus: a narrative review

Objective

Systemic Lupus Erythematosus (SLE) is a complex, chronic autoimmune disease with significant heterogeneity in its presentation and progression. Social determinants of health (SDH), including socioeconomic factors, health literacy and access to care, among others, can shape SLE outcomes. This review explores the impact and interaction of these factors across the entire lupus patient pathway – from presentation to therapeutic management and outcomes - and proposes targeted solutions to improve health equity and patient outcomes in SLE.

Methods

Narrative review, synthesizing findings from peer-reviewed studies published in the last decade, focusing on SDH influencing SLE outcomes.

Results

SDH were found to consistently influence the entirety of the SLE patient pathway. Lupus patients from lower socioeconomic backgrounds experience increased diagnostic delay, worse damage accrual and higher mortality rates. Health literacy emerged as a critical factor, with tailored educational interventions shown to improve therapeutic adherence. Geographic disparities were also significant, with persons living in rural areas reporting reduced access to specialist care compared to urban counterparts. Interventions addressing financial barriers, transportation assistance and remote healthcare options demonstrated potential to improve access and outcomes. Additional approaches are proposed, that take into account the intersection of multiple vulnerabilities, their correlation and their interaction with individual lupus characteristics, which result in cumulative effects on disease severity.

Conclusions

Social determinants of health have a profound and measurable impact on SLE outcomes, highlighting the need for multidisciplinary approaches to reduce disparities. Evidence supports targeted interventions aimed at answering local and individual patient contexts, but also multi-level policy changes that address the complexity of these determinants' intersections, to reduce disparities and improve lupus patient outcomes overall. Further studies are critically needed to understand the broader geographic and cultural implications of these social determinants, and longitudinal research should prioritize evaluating the implementation and scalability of strategies addressing these factors.