Black Women with Lupus Report Unfair Treatment

Social stressors, such as being treated poorly in a doctor’s office, can lead to negative disease outcomes, particularly among black women with lupus, a new study shows. The study, published in the Aug. 13 online issue of the American Journal of Public Health, highlights the role of social stressors in contributing to the progression of systemic lupus erythematosus (SLE) in black women. It is the first-known study to report that unfair treatment is associated with disease progression among black women, but not always as a result of racial discrimination. The study is based on a survey of 578 black women in Atlanta who sought treatment for systemic lupus erythematosus, which disproportionately affects black women. The women completed a questionnaire that included the self-administered version of the Brief Index of Lupus Damage (BILD), and the five-item version of the Everyday Discrimination Scale, a widely-used measure of discrimination in epidemiological studies. Led by David H. Chae, ScD, of the University of Maryland in College Park, Md., the researchers set out to explore whether unfair treatment, due to race or other reasons, is associated with cumulative disease damage in black women with lupus. There are no known studies that explore the relationship between poor treatment in a doctor’s office and the progression of lupus, but there have been studies that show that lupus is associated with racial disparities. So Chae and colleagues set out to assess whether race was a factor in the treatment of black women with systemic lupus erythematosus. How was unfair treatment measured? [[{"type":"media","view_mode":"media_crop","fid":"40557","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_7961844967212","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4176","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.0080003738403px; line-height: 1.538em; float: left;","title":" ","typeof":"foaf:Image"}}]]The Everyday Discrimination Scale measured being treated with less courtesy or respect, receiving poorer service, being perceived as less smart, being feared and being threatened or harassed. One hundred and fifty-nine (27.6%) of the women reported no unfair treatment and 418 (72.4%) reported unfair treatment.

• There was no statistically significant correlation between reported racial discrimination and organ damage.
• Previous studies also suggest that unfair treatment is a risk factor for worse health outcomes.
• Psychosocial stress, such as unfair treatment, may trigger inflammatory responses. 

_{Source:  American Journal of Public Health}

 “These social insults are commonly reported as salient sources of psychosocial stress, particularly among African American women, who in addition to contending with the immediate psychological and physical consequences of such experiences, have also expressed heightened vigilance in anticipation of being treated unfairly,” the researchers wrote. The BILD is a validated patient-reported measure of major irreversible organ damage in 12 organ systems, including stroke, loss of extremity, malignancy and premature gonadal failure. The frequency of unfair treatment was measured on a scale of zero (never) to five (almost every day). Women who reported any unfair treatment had a BILD score of 2.47, while women who did not had a significantly lower BILD score of 1.99. On average, unfair treatment scored 2.3.  Patients reported that each of the five types of unfair treatment occurred less than once a year. Women who reported unfair treatment were asked to give the main reason for that treatment, from the choices of ancestry or national origin, gender, race, age, height, weight, other physical appearance, sexual orientation and other (as reported by 144 patients citing attitudes, ignorance, personal behavior and unknown reasons). The findings suggest that unfair treatment in general is a risk factor for negative health outcomes. It can lead to stress, which can trigger inflammatory responses exacerbating pre-existing conditions. “Participants attributing unfair treatment to racial discrimination also had greater SLE damage than those reporting no unfair treatment; however, the associations were consistently lower in magnitude than for those attributing unfair treatment to nonracial factors, and they were not significantly different from those reporting no unfair treatment,” the researchers wrote. “This observation resonates with findings from other studies, which have reported that the effect of unfair treatment may differ according to whether it is perceived as being motivated by race or by other factors.” 

Why is this study important?

 Black women have a greater prevalence of lupus and are more frequently affected by organ damage and comorbidities that occur as a result of disease-related chronic inflammation and tissue damage. Studies have also shown that black women with lupus have an increased prevalence of renal and cardiovascular damage as compared to whites. They also have mortality rates that are up to three times higher as compared to whites and they disproportionately suffer from premature mortality. Stress is known to accelerate disease progression and heighten inflammatory conditions, which is especially distressing for patients with lupus. The Chae study’s findings are consistent with those from other studies, but there were limitations to the Chae study. It is based on self-reports of disease damage and other health indicators. It also does not include biological markers of disease severity or progression. 

References:

Chae DH, Drenkard CM, Lewis TT, Lim SS. Discrimination and Cumulative Disease Damage Among African American Women With Systemic Lupus Erythematosus.American Journal of Public Health. Online Aug 13, 2015. doi: 10.2105/AJPH.2015.302727