Background Several studies indicate that persons with SLE in poverty experience increased levels of accumulated damage compared to the non-poor. However, it is unknown as to whether leaving poverty reduces the amount of newly accumulated damage and over what time frame.
Objectives Describe impact of permanently leaving poverty on newly accumulated damage and the duration of time until the effects of poverty are attenuated.
Methods We used the UCSF Lupus Outcomes Study (LOS), a national longitudinal sample of persons with SLE interviewed annually. The survey collects data to assess whether individuals are ≤125% of the US Federal poverty level as well as a validated self-report battery of accumulated damage, the Brief Index of Lupus Damage (BILD)1. We used linear regression to analyze the impact of having left poverty permanently versus having remained in poverty or never having been in poverty and effect of # of years out of poverty on change in BILD between the 2009 and 2014, with and without adjustment for covariates. Covariates are listed in the footnote to Table 1, below.
Results 2009 LOS interviews included 750 persons with SLE, of whom 587 were interviewed through 2014. Of the 587, 461 (80%) were never in poverty between 2009 and 2014, 51 (9%) remained poor throughout, and 67 (12%) left poverty permanently. In 2009 mean BILD was 1.95 (std dev, 2.00), range 0–13; by 2014, mean BILD increase was 1.44 (std dev 1.71), range 0–13, a clinically meaningful increment in damage. Table 1 summarizes change in BILD as a function of having left poverty and for how long and shows that persons who left poverty experience similar levels of accumulated damage as those never in poverty; this occurs by 2–3 years after leaving poverty.
Conclusions Leaving poverty is associated with reduced levels of newly accumulated damage as soon as 2–3 years later, even when taking into account disease, demographics, medical care, and health behaviors. These results indicate that clinicians should be attentive to the burdens associated with poverty and that public policies to alleviate poverty not specifically geared to persons with SLE may contribute to the reduction of new damage in SLE.
Yazdany J, et al. Arthritis Care Res (Hoboken). 2011 Aug;63(8):1170–7. doi: 10.1002/acr.20503.
Acknowledgement Robert Wood Johnson Investigator Award in Health Policy and NIAMS P60-AR-053308 and 5R01AR56476
Disclosure of Interest E. Yelin Grant/research support from: NIAMS (NIH) and Robert Wood Johnson Foundation, L. Trupin Grant/research support from: NIAMS (NIH) and Robert Wood Johnson Foundation, J. Yazdany Grant/research support from: NIAMS (NIH) and Robert Wood Johnson Foundation