Neighborhood Socioeconomic Status and Short‐Term Functional Outcomes in Systemic Lupus Erythematosus

OBJECTIVE: Individuals with SLE can accumulate functional status (FS) impairment. We evaluated the association between neighborhood socioeconomic disadvantage, as measured by the area deprivation index (ADI), and FS in a national SLE sample. METHODS: Data were derived from RISE, a national electronic health record-based registry. Individuals aged 18+ with ≥ 2 visits for SLE ≥ 30 days apart and at least 1 functional status assessment measure (FSAM) in 2016-2022 were included. ADI was grouped into quintiles. Cross-sectionally, mean FS scores were compared across ADI quintiles, and multi-level regression models were used to examine the association between ADI and FS score. Similarly, a multi-level model was used to assess the association between ADI and FS decline. RESULTS: Mean age in the cross-sectional cohort (N=20,620) was 56.0 (SD 15.5) years; 91.4% were female, and 57.6% were non-Hispanic White. Baseline characteristics were similar in the longitudinal cohort (N=10,604). Adjusted mean FS scores were higher (worse) among those with higher ADI (ADI quintile 1 (highest SES): 1.53 [1.28-1.77]; quintile 5 (lowest SES): 1.90 [1.63-2.16]). 15.7% in the longitudinal cohort experienced FS decline. The proportion of patients with FS decline was greater with decreases in ADI (quintile 1: 11.4% [9.3%-13.5%]; quintile 5: 17.0% [13.7%-20.2%]). CONCLUSIONS: In this national sample of adults with SLE, greater neighborhood deprivation was associated with worse physical function and a higher likelihood of short-term functional decline. Clinical efforts to improve outcomes should include routine assessment of function and patient-centered interventions that acknowledge and help mitigate social and structural barriers to health.