A RECENT study has identified a significant association between neighbourhood deprivation and the severity of discoid lupus erythematosus (DLE) in adult patients, suggesting that social and environmental factors are crucial in disease outcomes.
The study was conducted by researchers at the University of Pennsylvania, Philadelphia, USA, and examined 154 adults with DLE from the Philadelphia area. The authors found that those living in more disadvantaged neighbourhoods (measured by the Area Deprivation Index [ADI]) experienced more severe disease activity and damage.
DLE is a chronic skin condition that can lead to significant scarring and disfigurement. It disproportionately affects women and is often more severe in individuals with systemic lupus erythematosus (SLE). The researchers used the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) to assess disease severity and compared this data against the ADI scores, which quantify the level of socioeconomic disadvantage in a given area.
The results showed that residents in areas with higher ADI scores had a nearly fourfold increase in the odds of experiencing moderate to severe DLE damage and activity. Additionally, the study found that current smokers had a threefold higher risk of severe disease, further emphasising the role of environmental and lifestyle factors in disease progression. Notably, when adjusting for ADI and other variables, race itself was not a significant predictor of disease severity, challenging the traditional focus solely on racial disparities in health outcomes.
This research suggests that interventions targeting the social and environmental contexts within which patients live could be crucial in managing DLE more effectively. The researchers call for a shift in healthcare strategies to include geographically targeted interventions and policy changes aimed at reducing the impact of socio-economic deprivation on chronic diseases like DLE. Addressing these broader social determinants of health has the potential to improve outcomes for patients living in disadvantaged areas.
Aleksandra Zurowska, EMJ
Reference
Faden D F et al. Area deprivation and disease severity in adult patients with discoid lupus erythematosus. JAMA Dermatol. 2024 [Epub ahead of print].
