In this competitive renewal of a highly successful grant investigating sociodemographic disparities in outcomes from systemic lupus erythematosus (SLE), including lupus nephritis and end-stage renal disease, we will turn our attention to the alarming and unexplained sociodemographic disparities that exist in SLE incidence. Most SLE patients are women and blacks have much higher incidence and poorer outcomes than whites. Moreover, within the population enrolled in Medicaid, the Federal-state insurance for low income Americans, we have shown increased SLE among those living in poorer areas. We will investigate three classes of potentially modifiable social and behavioral factors that may contribute to increased SLE incidence among black and low socioeconomic status women: 1. dietary factors and patterns, specifically fish (rich in anti-inflammatory omega-3 fatty acids), and the Western pro-inflammatory dietary pattern, characterized by fast food, high saturated fat, processed meats, potatoes, and sugar-sweetened soft drinks; 2. obesity, which induces systemic inflammation, and; 3. psychosocial factors including depressive symptoms, anxiety and exposure to abuse. We hypothesize that these exposures are associated with elevated biomarkers of SLE autoimmunity, as well as with incident SLE. We will utilize the largest collection of women followed prospectively prior to SLE, the Nurses' Health Study and the Black Women's Health Study cohorts, with rich data on dietary, lifestyle, psychosocial factors, and banked blood samples. With excellent statistical power, we will examine whether and how these exposures at different time periods of life may alter SLE risk among white and black women of a range of socioeconomic backgrounds. Our multidisciplinary investigative team spanning nutritional epidemiology, social and behavioral epidemiology, biostatistics, and rheumatology will employ advanced and innovative epidemiologic concepts and analyses. The proposed analyses will provide currently lacking information concerning potential epidemiologic explanations for observed sociodemographic disparities in SLE. The findings will have important public health and clinical implications, directly informing lifestyle interventions aimed at preventing and reducing disparities in SLE.

Public Health Relevance

In the U.S., systemic lupus erythematosus (SLE) is most common among black women and those of low socioeconomic class. We will investigate three classes of potentially modifiable social and behavioral factors that may contribute to increased SLE incidence among blacks and low SES women: 1. dietary factors and patterns, specifically fish (rich in anti-inflammatory omega-3 fatty acids), and the Western 'pro-inflammatory' dietary pattern, characterized by fast food, high saturated fat, processed meats, potatoes, and sugar- sweetened soft drinks; 2. obesity, which induces systemic inflammation, and; 3. depression symptoms and exposure to life stressors, which have also been linked to increased inflammation. Using the Nurses' Health Study and the Black Women's Health Study cohorts, with rich data on dietary, lifestyle, psychosocial factors, and banked blood samples, we will examine whether and how these exposures at different time periods of life may alter SLE risk among white and black women of a range of socioeconomic backgrounds, shedding light on the biologic mechanisms of this complex disease and its disparities, and informing lifestyle interventions for SLE prevention.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR057327-10
Application #
9768321
Study Section
Health Disparities and Equity Promotion Study Section (HDEP)
Program Officer
Wang, Yan Z
Project Start
2009-09-15
Project End
2020-08-31
Budget Start
2019-09-01
Budget End
2020-08-31
Support Year
10
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Barbhaiya, Medha; Feldman, Candace H; Guan, Hongshu et al. (2018) Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus. Semin Arthritis Rheum :
Broder, Anna; Mowrey, Wenzhu B; Golestaneh, Ladan et al. (2018) Methodological considerations in comparing access to Pre-emptive renal transplantation between SLE and other ESRD causes in the USRDS. Semin Arthritis Rheum :
Feldman, Candace H; Collins, Jamie; Zhang, Zhi et al. (2018) Dynamic patterns and predictors of hydroxychloroquine nonadherence among Medicaid beneficiaries with systemic lupus erythematosus. Semin Arthritis Rheum 48:205-213
Feldman, Candace H; Broder, Anna; Guan, Hongshu et al. (2018) Sex Differences in Health Care Utilization, End-Stage Renal Disease, and Mortality Among Medicaid Beneficiaries With Incident Lupus Nephritis. Arthritis Rheumatol 70:417-426
Lin, Tzu-Chieh; Marmor, Michael F; Barbhaiya, Medha et al. (2018) Baseline Retinal Examinations in Patients With Systemic Lupus Erythematosus Newly Initiating Hydroxychloroquine Treatment in a US Medicaid Systemic Lupus Erythematosus Population, 2000-2010. Arthritis Care Res (Hoboken) 70:1700-1706
Barbhaiya, Medha; Tedeschi, Sara K; Lu, Bing et al. (2018) Cigarette smoking and the risk of systemic lupus erythematosus, overall and by anti-double stranded DNA antibody subtype, in the Nurses' Health Study cohorts. Ann Rheum Dis 77:196-202
Cozier, Yvette C; Barbhaiya, Medha; Castro-Webb, Nelsy et al. (2018) A prospective study of obesity and risk of systemic lupus erythematosus (SLE) among Black women. Semin Arthritis Rheum :
Speyer, Cameron B; Costenbader, Karen H (2018) Cigarette smoking and the pathogenesis of systemic lupus erythematosus. Expert Rev Clin Immunol 14:481-487
Feldman, Candace H; Collins, Jamie; Zhang, Zhi et al. (2018) Azathioprine and Mycophenolate Mofetil Adherence Patterns and Predictors among Medicaid Beneficiaries with Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) :
Williams, J N; Chang, S-C; Sinnette, C et al. (2018) Pesticide exposure and risk of systemic lupus erythematosus in an urban population of predominantly African-American women. Lupus 27:2129-2134

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