Biopsychosocial Mechanisms of Disease Progression in Black Women with Systemic Lupus Erythematosus

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune condition that involves multiple organ systems and fluctuating disease activity which can lead to potentially debilitating symptoms, various morbidities, and mortality. SLE is further characterized by significant racial inequities that have widened over recent decades. Compared to white women, Black women experience faster disease progression and worse outcomes at earlier ages with limited evidence implicating biological or genetic factors. Rather, racial inequities in SLE have been linked to underlying social inequities, particularly those stemming from the legacy of racism and its contemporary forms. This dissertation examines how racism operates as a system of power through various multi-level pathways to shape inequities in disease outcomes for Black women living with SLE. Three studies were conducted to examine racism-related risk factors for disease progression at the individual-, biological-, and neighborhood-level among 438 Black women from the Black Women’s Experiences of Lupus (BeWELL) Study (2015-2019)—the largest study on the social epidemiology of SLE. The first study identified unique sociodemographic profiles of Black women with SLE and examined prospective associations with the timing and extent of organ damage accrual. The second study longitudinally examined how incident experiences of racial discrimination are linked with temporal increases in the inflammatory biomarker, C-reactive protein. The third study considered the role of racial residential segregation in shaping exposure to neighborhood-level risk factors for depression in SLE. Collectively, study findings indicate how various facets of racism drive adverse SLE outcomes among Black women, and identify specific mechanisms which contribute to widening racial SLE inequities. Public health strategies should address racism, particularly at the structural level, to improve health equity for Black women living with SLE and Black Americans, more broadly.