Multiplicative Adverse Effects of Social Determinants of Health in Lupus Nephritis: A Meta-analysis and Systematic Review Save

A metanalysis shows that social determinants of health adversely impacts patients with lupus nephritis (LN). 

Lupus nephritis is a significant complication of SLE, often with dramatic increases in morbid and mortal risks. Outcomes are likely to be augmented by social determinants of health (SDoH), including socio-economic status (SES), and social risk factors.

In this study, adverse SDoHs were defined as the presence of social barriers that could impact health outcomes - including lack of social support, depression, low literacy, poverty, limited access to care, unemployment, smoking, Medicaid insurance, uninsured, racism or discrimination, living in disadvantaged neighborhoods, food insecurity, homelessness, lack of transportation. Adverse SDoHs were grouped in four domains: 1) individual (e.g., insurance), 2) healthcare (e.g., fragmented care), 3) community (e.g., neighborhood SES), and 4) health behaviors (e.g., smoking) to show associations with poor LN outcomes. 

The metanalysis included 13 studies, including roughly 35,000 patients.  Poor LN outcomes included severe long-term disease outcomes, such as all-cause mortality, cardiovascular disease, or ESKD requiring dialysis or transplantation.

 Poor lupus nephritis outcomes were:

• 1.47-fold higher in patients with any adverse SDoH. 
• 1.64-fold and 1.77-fold higher odds of poor outcomes with adverse SDoH in individual and healthcare domains
• multiplicative effects in those having ≥2 adverse SDoH on LN outcomes
• Having ≥2 adverse SDoH in ≥1 SDoH domains had 12-fold higher odds of poor LN 
• Patients of Black Race with public insurance and fragmented care had 12-fold higher odds of poor LN outcomes.

Having ≥2 adverse SDoH, specifically in different SDoH domains, had a multiplicative impact leading to worse LN outcomes, widening disparities.