Background/Purpose Chronic Cutaneous Lupus Erythematosus (CCLE), including discoid lupus, often leads to scarring and disproportionately afflicts African American (AA) people. Smoking worsens the severity of skin lupus and is highly prevalent in those from disadvantaged groups. We examined sociodemographic disparities in tobacco smoking among patients with CCLE confined to the skin (primary CCLE [pCCLE]).

Methods Cross-sectional study of adults with dermatologist-diagnosed pCCLE consented into the Georgians Organized Against Lupus (GOAL) Cohort. GOAL is a population-based lupus cohort established in the Southeastern US, where there is a large AA, socioeconomically disadvantaged population. pCCLE were classified as never smokers (NS, <100 lifetime cigarettes), former smokers (FS, ≥100 lifetime cigarettes and not currently smoking), and current smokers (CS, ≥100 lifetime cigarettes and currently smoking). We created a Disadvantage Score (DScore) by attributing 1 point to each of the following: living below the federal poverty level, ≤ high school education, self-reported AA race, unemployed/disabled, self-perceived discrimination, and moderate/severe depression. We examined the association of DScore with active smoking (CS vs NS) and smoking cessation (CS vs FS).

Results Among 124 patients (86% females, 82% AA), the prevalence of NS, FS, and CS was 53%, 16%, and 31%, respectively. In multivariate models adjusting for age, sex and dermatology visits (table 1), the odds of CS (vs NS) increased significantly as the DScores increased (OR=3.9 and OR=9.3 for adults with DScores of 2–3 and 4–6 [compared with DS 0–1], respectively). Odds of CS (vs FS) were also higher with higher DScores (OR=6.9 and OR=7.6 for adults with a DS of 2–3 and 4–6 [compared with DS 0–1], respectively).

Conclusion Smoking is highly prevalent in patients with pCCLE. DScores were positively associated with CS and inversely associated with FS. Smoking cessation is particularly important for adults with pCCLE, and such efforts should target individuals from the most disadvantaged sociodemographic groups.

Acknowledgements The GOAL Cohort is supported by the Centers for Disease Control and Prevention (CDC) Grant 1U01DP005119. The content of this research is solely the responsibility of the authors and does not necessarily represent the official views of the CDC. The authors have no conflicts of interest to declare.