Unraveling Race, Socioeconomic Factors, and Geographical Context in the Heterogeneity of Lupus Mortality in the United States

OBJECTIVE: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease disproportionately affecting women and racial/ethnic minorities. We examined SLE‐related mortality over time to assess whether the impact of race is attenuated when social economic status (SES) and geographic context are also considered. METHODS: This study examined whether social environment attenuates racial disparities in SLE‐related mortality using race‐geographical combinations of the US population known as the “Eight Americas.” This framework jointly characterizes race, SES, and geographical location in relation to health disparities in the United States. Using National Vital Statistics and US Census data, we estimated mortality parameters for each of the Eight Americas. RESULTS: We identified 24 773 SLE deaths (2003‐2014). Average annual mortality rates were highest among blacks in three race‐geographical contexts: average‐income blacks, southern low‐income blacks, and high‐risk urban blacks (14 to 15 deaths per million population) and lowest among nonblacks living in average‐income settings (3 to 4 deaths per million population). Age at death was lowest (~47.5 years) for blacks and Asians and highest among low‐income rural whites (~64.8 years). CONCLUSION: Blacks sharing the same social and geographical contexts as whites were disproportionately more likely to die young. Although blacks inhabited three vastly different contexts, SLE‐related mortality parameters did not vary among socially advantaged and disadvantaged blacks. These findings suggest that race may transcend SES and geographical parameters as a key determinant of SLE‐related mortality.