Objective To study the association between economic status and the lived experience of systemic lupus erythematosus (SLE) patients.

Methods Data on the economic status of participants in the Living with Lupus in 2020 (LWL2020) survey by Lupus Europe were analysed.¹ Participants were categorised into two groups: those frequently facing difficulties in paying bills (lower economic status - LES) and those never facing such challenges (Affluent), and the burden of SLE was compared between these 2 groups. 1172 patients ‘occasionally facing difficulties’ were ignored.

Results Among the 763 LES patients (96.2% women, mean age 44.6 ± 10.4) and 2052 affluent patients (96.2% women, mean age 46.3 ±12.7) studied. Patients with lower ES faced a delayed SLE diagnosis (average additional delay: +0.9 years). 53.6% faced another diagnosis before SLE compared to 41.2% of affluent. Fibromyalgia (10.2% vs. 4.2%) and psychologic disorder (14.4% vs. 7.1%) prior diagnosis were largest differences. LES patients considered themselves less active than others of the same age due to lupus (84.9% vs. 65.1%), with SLE less often under control over the past 3 months (60.6% vs. 78.1%). They listed an average of 10.3 (±3.6) symptoms compared with 7.9 (±3.6) for affluent patients, with key increases in thrombosis (2.2x), Chest Pain (1.75x), depression/anxiety (1.67x), and Hematologic/anemia (1.63x). They were taking 5.9 (±2.6) medications vs. 4.9 (+/-2.3) for affluents, with key increases in anxiolytics/antidepressants (2.47x) and painkillers (1.43x), They rated all categories of access to treatments slightly lower, with an average of 3.09 (±0.9) vs. 3.49 (+/-0.8) (on a scale of 1 to 5) and faced lower health related quality of life in all 5 EQ5D dimensions (average burden of 2.98 ±0.68 compared to 2.26 ±0.71). Finally, their concerns about lupus progressing were substantially more frequent with 76.2% of high or very high worry (>7/10) compared to 54.9% for affluent patients.

Conclusions This analysis highlights a significantly worse lupus experience among patients of lower economic status. Diagnosis delay, increased number of reported symptoms, psychologic status, increased number of medications, lower activity level all contributed to a lower quality of life.

Reference

1. Cornet A, Andersen J, Myllys K, et al. Living with systemic lupus erythematosus in 2020: a European patient survey. Lupus Science & Medicine 2021;8:e000469. doi:10.1136/lupus-2020–000469.