Association between social determinants of health and systemic lupus erythematosus: a nationally representative analysis of 2017–2021 data

Limited US recent data is available on the prevalence of systemic lupus erythematosus (SLE) by patient's social determinants of health (SDOH). Careful assessment of individual SDOH that affects SLE is crucial, as such evidence could help improve care and hence reduce health disparities for patients with SLE, especially for those who are most vulnerable and at the highest risk of poor outcomes. We estimated the prevalence of systemic lupus erythematosus (SLE) overall and by patient's social determinants of health (SDOH), and also explored the associations between SDOH and SLE. We conducted a population-based cross-sectional study using Medical Expenditure Panel Survey 2017-2021 data. Patients with SLE were those with both SLE diagnosis and either had SLE-related medication use and/or visited a rheumatologist in the survey year. SDOH domains included economic stability, education, healthcare access and quality, social and community context, and neighborhood and built environment. Average annual prevalence of SLE by SDOH was determined. Separate logistic regressions were used to examine the association between each SDOH and SLE, controlling for confounders. Average annual SLE prevalence was 199 per 100,000 US adults (95% confidence intervals:170-224). In the economic stability domain, those with low family income showed higher odds of SLE than those with high family income (adjusted odds ratio (AOR) = 2.779, p < 0.05). Within the social and community context and neighborhood and built environment domains, non-Hispanic Black patients (AOR = 2.429, p < 0.05) and patients with any psychological distress (AOR = 2.127, p < 0.05) had higher odds of SLE, than their respective counterparts, respectively. Within the healthcare access and quality domain, those with Medicaid insurance had higher odds of SLE (AOR = 2.540, p < 0.05) than those with private insurance. Also, patients in the highest SDOH burden quartile had higher odds of SLE (AOR = 2.039, p < 0.05) than those in the lowest SDOH burden quartile. We identified several subgroups of patients especially those with higher social disadvantage and a higher SDOH burden. The prevalence of SLE increased with a higher SDOH burden.