POS1170 DISCRIMINATION AND SOCIAL SUPPORT AMONG BLACK WOMEN WITH AND WITHOUT SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Authors: J. T. Browder, S. Smith, C. Mattila, C. Dunlop-Thomas, L. Q. King, L. A. Ueberroth, E. M. Williams, S. S. Lim, D. L. Kamen, B. J. Wolf, P. S. Ramos
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Black or African American women are disproportionately affected by SLE [1, 2]. but remain underrepresented in research studies. The relationships between discrimination, social support and SLE disease outcomes have not been thoroughly investigated in Black women with SLE. <h3>Objectives:</h3> The goal of this study is to evaluate the relationship between racial discrimination, social support, and disease outcomes in Black women with SLE. <h3>Methods:</h3> Adult Black women meeting either the 1997 ACR revised criteria or the SLICC criteria for SLE and a control group without any connective tissue disease were recruited for this study. SLE disease activity was measured using the SLE Disease Activity Index (SLEDAI) and the Systemic Lupus Activity Questionnaire (SLAQ), and SLE organ damage was measured using the Brief Index of Lupus Damage (BILD). Discrimination was measured using the Experiences of Discrimination (EOD) questionnaire, a validated multi-item measure used to assess experiences of racial discrimination. Social support was measured using the validated Medical Outcomes Study-Social Support (MOS-SS) survey. A Welch two sample t-test was computed for the associations between EOD and SLAQ, and a Wilcoxon rank sum test with continuity correction was computed for EOD and BILD. A linear model was also computed to test for association between EOD and log-transformed BILD, controlling for age. Associations between SLE status and overall MOS-SS score, as well as the MOS-SS support domains, were analyzed using a series of Wilcoxon rank-sum tests, with Hodges-Lehmann estimation to calculate confidence intervals for the difference in medians. Among participants with SLE, associations between MOS-SS score with SLEDAI and with BILD were evaluated using Spearman's rank correlation. All analyses were performed on RStudio v4.0.3. <h3>Results:</h3> This study comprised 182 self-identified Black females, 101 with SLE. The mean (±SD) age of participants with SLE was 46.9±11.6 years, and the mean age of controls was 48.4±13.0 years. Among those with SLE, disease duration at the study visit was 17.1±8.8 years. Although some sociodemographic and behavioral characteristics were similar in patients and controls (e.g., 30% were married, 86% rarely or never drank), many other characteristics differed between the groups. Of controls, 89% reported experiencing racial discrimination, compared to 81% of SLE participants. No association was found between racial discrimination and SLE activity or organ damage after adjusting for age. Overall, MOS-SS scores did not significantly differ between patients and controls, with both groups reporting that, on average, social support is available to them some of the time. When considering the MOS-SS support domains, patients with SLE had a lower score for the positive social interaction domain (e.g., someone to have a good time with) than controls (p = 0.048). Among patients with SLE, an association was found between overall MOS-SS and SLEDAI scores, such that higher SLEDAI scores were associated with lower MOS-SS scores (ρ = -0.28, p = 0.039). <h3>Conclusion:</h3> This study conducted in participants from coastal South Carolina found higher rates of personal experiences with racial discrimination than a national survey,<sup>1</sup> but similar to those reported in a previous study of Black women with SLE living in Atlanta, Georgia.<sup>2</sup> Unlike this previous report,<sup>2</sup> the current study did not find associations between racial discrimination and SLE activity nor organ damage. Our study found an inverse correlation between physician reported disease activity and overall social support. Further investigation into whether targeted interventions to improve social support could improve SLE outcomes is warranted. Given the heterogeneity of Black communities, continued recruitment into this study and increased sample size is expected to enhance our knowledge about SLE in this population. <h3>REFERENCES:</h3> [1] Pew Research Center. On Views of Race and Inequality, Blacks and Whites Are Worlds Apart. June 27, 2016. [2] Chae <i>et al</i>. Racial Discrimination, Disease Activity, and Organ Damage: The Black Women's Experiences Living With Lupus (BeWELL) Study. Am J Epidemiol. 2019;188:1434-1443. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>