The impact of rural residency on the expression and outcome of systemic lupus erythematosus: data from a multiethnic Latin American cohort

Objective: The objective of this paper is to examine the role of place of residency in the expression and outcomes of systemic lupus erythematosus (SLE) in a multi-ethnic Latin American cohort. Patients and methods: SLE patients (<two years of diagnosis) from 34 centers constitute this cohort. Re...

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Published in:	Lupus Vol. 21; no. 13; pp. 1397 - 1404
Main Authors:	Pons-Estel, GJ, Saurit, V, Alarcón, GS, Hachuel, L, Boggio, G, Wojdyla, D, Alfaro-Lozano, JL, de la Torre, I García, Massardo, L, Esteva-Spinetti, MH, Guibert-Toledano, M, Gómez, LA Ramirez, Costallat, LT Lavras, del Pozo, MJ Sauza, Silveira, LH, Cavalcanti, F, Pons-Estel, BA
Format:	Journal Article
Language:	English
Published:	London, England SAGE Publications 01-11-2012 Sage Publications Ltd
Subjects:	Adult African Continental Ancestry Group - statistics & numerical data Age Age Factors American Native Continental Ancestry Group - statistics & numerical data Chi-Square Distribution Comorbidity Continental Population Groups - statistics & numerical data Cyclophosphamide Cyclophosphamide - therapeutic use Data processing Disease Progression Educational Status Ethnic groups Ethnicity European Continental Ancestry Group Female Health care access Health Services Accessibility - statistics & numerical data Healthcare Disparities - ethnology Hemodialysis Hospitals Humans Hypertension Hypertension - ethnology Immunosuppressive Agents - therapeutic use Kidney Kidney diseases Latin America - epidemiology Logistic Models Longitudinal Studies Lupus Lupus Erythematosus, Systemic - diagnosis Lupus Erythematosus, Systemic - ethnology Lupus Erythematosus, Systemic - therapy Lupus Nephritis - ethnology Male Medically Uninsured - ethnology Methotrexate Methotrexate - therapeutic use Mortality Multivariate Analysis Odds Ratio Prognosis Regression analysis Renal Dialysis Residence Characteristics - statistics & numerical data Rheumatology Risk Factors Rural areas Rural Health - statistics & numerical data Rural populations Socio-economic aspects Socioeconomic Factors Systemic lupus erythematosus Time Factors Urban Health - statistics & numerical data White people Young Adult Latin America Brazil Mexico Argentina Chile Spain
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Summary:	Objective: The objective of this paper is to examine the role of place of residency in the expression and outcomes of systemic lupus erythematosus (SLE) in a multi-ethnic Latin American cohort. Patients and methods: SLE patients (<two years of diagnosis) from 34 centers constitute this cohort. Residency was dichotomized into rural and urban, cut-off: 10,000 inhabitants. Socio-demographic, clinical/laboratory and mortality rates were compared between them using descriptive tests. The influence of place of residency on disease activity at diagnosis and renal disease was examined by multivariable regression analyses. Results: Of 1426 patients, 122 (8.6%) were rural residents. Their median ages (onset, diagnosis) were 23.5 and 25.5 years; 85 (69.7%) patients were Mestizos, 28 (22.9%) Caucasians and 9 (7.4%) were African-Latin Americans. Rural residents were more frequently younger at diagnosis, Mestizo and uninsured; they also had fewer years of education and lower socioeconomic status, exhibited hypertension and renal disease more frequently, and had higher levels of disease activity at diagnosis; they used methotrexate, cyclophosphamide pulses and hemodialysis more frequently than urban patients. Disease activity over time, renal damage, overall damage and the proportion of deceased patients were comparable in rural and urban patients. In multivariable analyses, rural residency was associated with high levels of disease activity at diagnosis (OR 1.65, 95% CI 1.06–2.57) and renal disease occurrence (OR 1.77, 95% CI 1.00–3.11). Conclusions: Rural residency associates with Mestizo ethnicity, lower socioeconomic status and renal disease occurrence. It also plays a role in disease activity at diagnosis and kidney involvement but not on the other end-points examined.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0961-2033 1477-0962
DOI:	10.1177/0961203312458465