Discrimination tied to poor patient outcomes in SLE

Racial and ethnic discriminations appear to result in greater patient-reported disease activity, pain, fatigue, depression, and anxiety among patients with systemic lupus erythematosus (SLE), a recent study has shown.

A team of investigators analysed data from the California Lupus Epidemiology Study, consisting of 245 diverse participants (31 percent Asian, 10 percent Black, 24 percent Hispanic, and 34 percent White).

Participants completed the Everyday Discrimination Scale (EDS) and the following patient-reported outcomes (PROs): Systemic Lupus Activity Questionnaire (SLAQ), Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference and Fatigue scales, 8-item Patient Health Questionnaire (PHQ-8) for depression, and 7-item Generalized Anxiety Disorder (GAD-7) for anxiety.

The investigators used multivariable linear regressions to explore the associations between discrimination and PROs. They also conducted mediation analyses to determine whether depression or anxiety mediated the relationships between discrimination and SLAQ, pain, or fatigue.

Asians and Blacks were the most discriminated participants, as shown by their high EDS scores. Multivariate analysis revealed the association of higher discrimination with worse SLAQ (β, 0.25; p<0.001), PHQ-8 (β, 0.21; p<0.001), GAD-7 (β,0.27; p<0.001), pain (β, 0.24; p=0.01), and fatigue (β, 0.30; p=0.007). Moreover, discrimination significantly correlated with higher SLAQ among Black and Asian participants.

However, after adjusting for PHQ-8 or GAD-7, the association of discrimination with SLAQ, pain, or fatigue was no longer significant.

“Mediation analyses suggest that mental health mediates the relationship between discrimination and PROs,” the investigators said. “These results highlight the effect of discrimination as a psychosocial stressor on disease outcome variables.”