It is often said that, despite the high number of uninsured in the U.S., ultimately people get the care they need. Sadly, even in a severe disease like SLE, that is not necessarily the case. A study recently presented in two abstracts at the Annual Meeting of the ACR showed that in basic indicators of the quality of SLE care, there were systematic differences in quality on the basis of the kind of insurance one had and, worse, the proportion receiving care consistent with the indicators was substantially lower among those without insurance compared even to the worst group with insurance.3 The specialty of the main SLE physician also mattered in the quality of care received.
Putting It All Together
Research addressing why women and members of racial and ethnic minorities have higher rates of SLE and then do more poorly after diagnosis has made much progress over the last decade. Clearly, genetic predisposition plays a role in the onset of SLE, but so do the nature of economic disadvantage, the effects of racial and gender discrimination, the burdens of living in communities with high concentrations of the poor, and heightened exposure to environmental triggers of disease.
After onset, economic disadvantage plays an important role by limiting the resources, economic and otherwise, to deal with the cascade of medical needs, by heightening external stress in a stress-mediated disease, and by limiting access to the healthcare resources known to improve outcomes. The latter may include having providers with a lot of experience in the disease, having providers practiced at communicating effectively with those with complex diseases like SLE, having insurance and, when insured, having the kind of insurance which provides access to a broad range of experienced providers, and living in communities that lack such providers and also lack others who know how to find those providers. the rheumatologist
Dr. Yelin is adjunct professor, School of Medicine, Division of Occupational and Environmental Medicine at the University of California, San Francisco, and among the leadership of The Lupus Initiative.
References
- Trupin L, Tonner MC, Yazdany J, et al. The role of neighborhood and individual socioeconomic status in outcomes of systemic lupus erythematosus. J Rheum. 2008;35:1782-1788.
- May C, Montori VM, Mair FS. We need minimally disruptive medicine. BMJ. 2009;2011;339:b2803.
- Yazdany J, Trupin LS, Tonner C, et al. Quality of care in patients with systemic lupus erythematosus. Arthritis Rheum. 2010;62:(S10):2113.
- Yelin EH, Yazdany J, et al. The effect of health insurance and physician speciality on quality of care for SLE. Arthritis Rheum. 2010;62(S10):789.
