There is a lack of research on systematic lupus erythematosus (SLE), a multisystem, chronic, autoimmune disease that shows clear patterns along racial and gender lines. African American women not only have a greater prevalence of SLE, but also experience greater severity and faster progression compared to their White counterparts, being more frequently affected by organ damage and comorbid conditions that emerge as a consequence of disease activity and disease-related chronic inflammation and tissue damage. Racial disparities in SLE complications and mortality are well documented; however, the reasons for these disparities are poorly understood. To address these gaps in knowledge, this study aims to: (1) examine the role that psychosocial stressors experienced by African American women have in exacerbating SLE in this population; (2) identify social factors and psychological resources that are protective or buffer the effects of stress on SLE-related health declines; and (3) explore the biological implications of psychosocial stressors and SLE, in relation to elevated systemic inflammation and accelerated aging at the cellular level. The experiences of African American women with SLE are particularly challenging, and include psychosocial stressors related to disease management, as well as disproportionately greater poverty and living in disadvantaged communities; in addition to routine stressors such as those associated with work, family and relationship demands, parenting, and caregiving. Experiences of racial discrimination constitute a qualitatively distinct source of psychosocial stress, adding o existing everyday hassles. In this study, we will examine how these stressors impact SLE severity and progression through a longitudinal study design. We will collect three waves of data from 480 African American women, all with validated SLE. Participants will be recruited from the Georgians Organized Against Lupus (GOAL) cohort, a truly one-of-a-kind, population-based study of SLE in Atlanta, including a full spectrum of patients from all levels of socioeconomic strata, across a range of disease severity. We will examine the effects of racial discrimination, financial and neighborhood-related strains, and other stressors associated with various role strains. Potential protective factors, including those related to racial identity and social suppor will also be assessed. We will collect dried blood spots (DBS), a minimally invasive alternative to venipuncture, to examine indicators of biological dysregulation which we hypothesize will be impacted by psychosocial stress as well as SLE activity. This study will be the most in-depth investigation of the multifactorial nature of psychosocial stressors and their impact on SLE disease progression among African American women, and thus fills an important gap in the science on this understudied disease. This research is important in advancing knowledge of how aspects of the social environment and psychological processes impact health among African American women with SLE, and also contributes to scientific knowledge on the underpinnings of racial disparities in the progression of this disease.

Public Health Relevance

African American women are disproportionately affected by systematic lupus erythematosus (SLE) and also face worse consequences of disease activity. This proposed study is important to helping improve our understanding of how psychosocial stressors that are salient in the lives of African American women, and in particular experiences of racial discrimination, exacerbate SLE severity and progression. Accomplishing the specific aims of this research will help to unravel factors contributing to racial disparities in this understudied disease, and will also help to identify potential targets of intervention?

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Tonkins, William P
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University of Maryland College Park
Biostatistics & Other Math Sci
Schools of Public Health
College Park
United States
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Plantinga, L; Lim, S S; Bowling, C B et al. (2017) Perceived stress and reported cognitive symptoms among Georgia patients with systemic lupus erythematosus. Lupus 26:1064-1071
Plantinga, Laura; Lim, S Sam; Patzer, Rachel et al. (2016) Incidence of End-Stage Renal Disease Among Newly Diagnosed Systemic Lupus Erythematosus Patients: The Georgia Lupus Registry. Arthritis Care Res (Hoboken) 68:357-65
Knight, Jessica H; Howards, Penelope P; Spencer, Jessica B et al. (2016) Characteristics related to early secondary amenorrhoea and pregnancy among women diagnosed with systemic lupus erythematosus: an analysis using the GOAL study. Lupus Sci Med 3:e000139
Plantinga, Laura; Lim, S Sam; Bowling, C Barrett et al. (2016) Association of age with health-related quality of life in a cohort of patients with systemic lupus erythematosus: the Georgians Organized Against Lupus study. Lupus Sci Med 3:e000161
Plantinga, Laura C; Lim, S Sam; Patzer, Rachel E et al. (2016) Comparison of vascular access outcomes in patients with end-stage renal disease attributed to systemic lupus erythematosus vs. other causes: a retrospective cohort study. BMC Nephrol 17:64
Chae, David H; Drenkard, Cristina M; Lewis, Tené T et al. (2015) Discrimination and Cumulative Disease Damage Among African American Women With Systemic Lupus Erythematosus. Am J Public Health 105:2099-107
Plantinga, Laura C; Patzer, Rachel E; Drenkard, Cristina et al. (2015) Association of time to kidney transplantation with graft failure among U.S. patients with end-stage renal disease due to lupus nephritis. Arthritis Care Res (Hoboken) 67:571-81
Plantinga, Laura C; Patzer, Rachel E; Drenkard, Cristina et al. (2015) Comparison of quality-of-care measures in U.S. patients with end-stage renal disease secondary to lupus nephritis vs. other causes. BMC Nephrol 16:39
Plantinga, Laura C; Drenkard, Cristina; Patzer, Rachel E et al. (2015) Sociodemographic and geographic predictors of quality of care in United States patients with end-stage renal disease due to lupus nephritis. Arthritis Rheumatol 67:761-72