What makes these patients different? “In PROMISSE, we observed health outcome disparities in the absence of healthcare disparities. Non-white patients came to doctor visits and had the same level of healthcare as the white patients. Is it stress from poverty or lack of social support? Were they taking their medications? Did they understand the physician’s instructions? It’s easy for scientists to say, ‘It’s genetics,’ but there is solid research indicating that we may be glossing over the social determinants of health disparities. We must consider the other aspect of our patients’ lives—social position—which is causally linked to health.”
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Dr. Salmon notes, “I don’t believe the problem is communication between doctor and patient. I think it may be related to patient education, trust and social support structure. We must carefully look at social factors within these communities.”
But where to begin?
Dr. Salmon says, “We need to use the best instruments to assess socioeconomic and environmental factors, as well as the importance of genetic risk factors, in another prospective study designed to assess all of these variables at the individual patient level. And we must be vigilant about providing community-based education and support in pregnant lupus patients at increased risk of complications.”
To go forward, we need to go backward … back to the data with more questions. Then we can progress toward addressing the specific, daily needs of lupus patients.
Elizabeth Hofheinz, MPH, MEd, is a freelance medical editor and writer based in the Greater New Orleans area.
- Yelin E, Trupin L, Yazdany J. A prospective study of the impact of current poverty, history of poverty, and exiting poverty on accumulation of disease damage in SLE. Arthritis Rheumatol. 2017 Aug;69(8):1612–1622.
- Kaplowitz ET, Ferguson S, Guerra M, et al. Socioeconomic status contributes to racial/ethnic disparities in adverse pregnancy outcomes among women with systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2017 May 8. doi: 10.1002/acr.23263. [Epub ahead of print]