Background Low socioeconomic status (SES) can affect outcomes in a chronic disease. This could be due to lack of access to healthcare including physician visits and medications and/or due to health related behaviors that may be associated with low SES. This has been demonstrated in some studies where global health care is lacking. The purpose of this study was to determine if SES affected SLE outcomes (for activity and damage) in a large Canadian cohort where there is global healthcare except that medications are not universally provided by the healthcare system.
Objectives We wanted to determine whether socioeconomic status, as measured by education, had an impact on disease activity (measured by SLAM-2, SLEDAI-2K) or disease damage (measured by SLICC SDI) in patients with systemic lupus erythematosus (SLE).
Methods Data was gathered from the 1000 Canadian Faces of Lupus, a multi-center, prospective cohort database and included adult SLE patients from June 2005 onward. Socioeconomic status, as measured by education was defined as being either low (did not complete high school) or high (completed high school or further). The relationship between socioeconomic status, as measured by education and SLE outcomes were evaluated using one-way ANOVA and logistic regression analyses.
Results There were 484 patients who met the inclusion criteria (mean age 47 years, 91.5% female, mean disease duration of 10 years). Of the included patients, 80.4% had completed high school education or higher and 19.6% had not completed high school. One-way ANOVA analyses of education level to SLE outcomes of disease activity (SLAM-2 and SLEDAI-2K) and disease damage (SLICC) demonstrated the following: SLICC, p=1.0, SLAM-2, p=0.3 and SLEDAI-2K, p=0.011. Further logistic regression analysis of SLEDAI-2K did not demonstrate significance with multiple variables including age, p=0.8, gender, p=1.0, ethnicity, p=0.7 and disease duration, p=0.5.
Conclusions Socioeconomic status, as measured by education, when adjusting for confounding variables, does not appear to have an impact on SLE patient outcomes as measured by disease activity (SLAM-2 and SLEDAI-2K) or disease damage (SLICC). This could be due to the fact that the patients enroling in a cohort have better health related behaviors and/or better education or other measures of SES than those who do not or it could be due to universal healthcare negating SES effects, or for other reasons including that SES does not currently affect outcomes in SLE. A population study of all SLE patients in a country with universal healthcare may be needed to confirm these results.
Disclosure of Interest None declared