Edward H. Yelin, PhD, emeritus professor in the Department of Medicine (Division of Rheumatology) and Philip R. Lee Institute for Health Policy Studies at UCSF, will discuss the variability in management and clinical outcomes by socioeconomic status, ethnicity/race, and access to care. Data indicate outcomes and survival in SLE have improved dramatically over the past several decades, indicating that improvements in medical care have made a difference. However, members of racial and ethnic groups and those of lower socioeconomic status have not shared in these gains in quality and quantity of life. This presentation will explore the reasons that these groups remain at a disadvantage, focusing both on what we know about their interactions with health providers and healthcare systems accounts for lingering disparities, as well as what about their lives outside of healthcare contributes to the disparities.
Because stresses associated with food, housing and medical care insecurity and exposure to the threat or actual experience of crime in their neighborhoods play roles in SLE outcomes for the poor, the presentation will discuss what it is reasonable to ask health providers to do to deal with these issues, traditionally not seen as within the provider’s purview.
Dr. Yelin’s work is focused on disparities in access to care and outcomes for people with severe autoimmune diseases, including SLE. His research in this area is funded by the UCSF Multipurpose Clinical Research Center, which emphasizes the causes and consequences of health disparities, and by an Investigator Award in Health Policy from the Robert Wood Johnson Foundation.
Ram Raj Singh, MD, MBBS, professor of medicine and pathology, UCLA Division of Rheumatology, and an ACR fellow, will highlight the issues related to high mortality in people with SLE. Although the mortality rate in the general population declined every year from 1968–2013, there was a rise in SLE-ASMR in the 1970s–90s followed by a decline in recent years. It is disappointing that, relative to the general population mortality, SLE mortality is higher in 2013 than in 1968.
Importantly, significant gender, racial and regional disparities persist in SLE mortality. Dr. Singh plans to discuss various measures of chronic disease mortality, including age-standardized mortality rate, case fatality, standardized mortality ratio, leading cause-of-death ranking and proportional death burden in SLE.
Time permitting, he will discuss the estimated national prevalence of SLE with its racial/ethnic, gender and geographic region variation.
Dr. Singh’s research interests include the pathogenesis of autoimmunity, with a focus on the role of T cells and dendritic cells, mechanisms of sexual dimorphism in autoimmune diseases and secular trends in autoimmune disease mortality with a focus on mechanisms underlying the disparities.