Volume 16 Supplement 1

Lupus 2014: New Targets, New Approaches

Open Access

Disease features and outcomes among US lupus patients of Hispanic origin and their Mestizo counterpart in Latina America

  • Manuel Ugarte-Gil1,
  • Guillermo J Pons-Estel2,
  • Daniel Wojdyla3,
  • Gerald McGwinJr4,
  • Bernardo A Pons-Estel5 and
  • Graciela S Alarcón4Email author
Arthritis Research & Therapy201416(Suppl 1):A33

https://doi.org/10.1186/ar4649

Published: 18 September 2014

Background

Systemic lupus erythematosus (SLE) US Hispanic patients with a large Amerindian ancestral background have been found to have poor outcomes. Similar observations have been made in the mixed population of Latin America. We are now comparing and contrasting selected sociodemographic and clinical features and outcomes of lupus patients from these two groups.

Methods

SLE US Hispanic patients (European and Amerindian ancestry) from the LUMINA cohort (Lupus in Minorities: Nature vs. Nurture) and Latin American Mestizo patients from the GLADEL cohort (Grupo LatinoAmericano De Estudio de Lupus (Latin American Group for the Study of Lupus)) constitute the study population. Only patients who fulfilled four of the 1997 ACR criteria were included. Diagnosis time was time to the fourth criterion. Demographic and clinical data from these patients were extracted. When the ascertainment method for a specific variable was different in both cohorts, this has been noted. All variables were then compared using descriptive statistical tests. Adjustment for disease duration was done when indicated using either a Poisson regression or logistic regression, as appropriate.

Results

Salient features for these two patient groups are presented in Table 1. Some of the differences observed in terms of the socioeconomic features could be due to the different methods of ascertainment.
Table 1

Salient features of US Hispanic SLE patients from LUMINA and Latin America Mestizo patients from GLADEL (at diagnosis or at last visit)

Characteristic

LUMINA (n = 114)

GLADEL (n = 619)

P value

Age, mean (SD)

31.3 (12.2)

29.4 (12.6)

0.138

Gender (female), n (%)

106 (93.0)

546 (88.2)

0.135

Disease duration (years), mean (SD)

6.1 (4.3)

4.5 (4.6)

<0.001

Low SESa, n (%)

42/107 (39.3)

391 (63.2)

<0.001

Health insurance, n (%)

56/112 (50.0)

466/615 (72.5)

<0.001

Acute onset, n (%)

34 (29.8)

151 (24.4)

0.220

ACR criteria numberb, mean (SD)

6.8 (1.6)

6.3 (1.5)

0.069

Disease activity (moderate-high)c, n (%)

78/92 (84.8)

438/493 (88.8)

0.268

Renal disorder, n (%)

60 (52.6)

370 (59.8)

0.155

SDI score at last visitb, mean (SD)

2.3 (2.6)

1.7 (1.7)

<0.001

Renal damage (per SDI, at last visit)d, n (%)

37 (32.5)

184 (29.7)

0.559

Deceasedd, n (%)

21 (18.4)

35 (5.7)

<0.001

SES, socioeconomic status; ACR, American College of Rheumatology; SDI, SLICC (Systemic Lupus International Collaborating Clinics) Damage Index. aSES defined as being below the Federally-defined poverty line for LUMINA and as per the Graffar method for GLADEL. bAfter adjusting for disease duration in a Poisson regression model. cDefined as a SLAM (Systemic Lupus Activity Measure) >7 for LUMINA and a SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) >4 for GLADEL. dSignificant after adjusting for disease duration using a Poisson regression model (for the SDI) and logistic regression for mortality

Conclusions

Patients in both cohorts exhibited active disease, with renal involvement and damage being frequent, and overall damage accruing rapidly; however, the US Hispanic patients exhibited a higher mortality. These two patient groups were also of low SES. These data suggest that these two populations share an underlying genetic background which coupled with a poor SES places them at increased risk for severe lupus with unfavorable short, intermediate and long-term outcomes. The less favorable mortality experience of the US Hispanics deserves to be further examined.

Declarations

Acknowledgements

Thanks to LUMINA and GLADEL investigators on whose behalf this work is being presented.

Authors’ Affiliations

(1)
Universidad Cieantífica del Sur and Hospital Nacional Guillermo Almenara Irigoyen
(2)
Institut Clínic de Medicina i Dermatología, Hospital Clínic
(3)
Escuela de Estadística, Universidad Nacional de Rosario
(4)
The University of Alabama at Birmingham
(5)
Hospital Provincial de Rosario

Copyright

© Ugarte-Gil et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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