What have we learned from a 10-year experience with the lumina (Lupus in Minorities; Nature vs. nurture) cohort? Where are we heading?
Introduction
Over the last few decades there has been an increased recognition of the variations in the expression and clinical course of acute and chronic diseases in patients from different ethnic groups, whether they are studied in their country of birth or not. These phenotypic differences may be explained by biologic–genetic factors or socioeconomic–demographic and psychosocial–behavioral factors or by the interaction between factors from these different domains. We established in 1994 a cohort of patients with systemic lupus erythematosus (SLE) of Hispanic, African American and Caucasian ancestry, in order to understand the relationship between ethnicity and this autoimmune disease [1]. We called this cohort LUMINA, for LUpus in MInorities: NAture vs. nurture). At the present time, the LUMINA cohort is constituted by patients from three geographic areas and medical institutions: The University of Alabama at Birmingham, The University of Texas-Houston Health Science Center and The University of Puerto Rico Medical Sciences Campus. The last one was added in 2001 in order to diversify the LUMINA Hispanic patient group and make it more comparable to the US Hispanic population. As of October 2003, the cohort consists of 587 patients (110 Hispanics from Texas, 85 Hispanics from Puerto Rico, 215 African Americans and 177 Caucasians), with a mean follow-up time of 40 months (range 0–113 months). Seventy-one percent of LUMINA patients are prevalent and 29% are incident cases (less than 6 months of disease duration at enrollment into the cohort).
We will now briefly review some salient features of the cohort, what we have learned in terms of possible predictors of outcome and finally describe where we are heading as we start LUMINA's second decade of fruitful existence. Given that the Hispanics from Puerto Rico entered the cohort relatively recently, most of the analyses to be presented include only the Hispanic patients from Texas (primarily of Mexican ancestry).
Section snippets
Patients characteristics
The majority of LUMINA patients are women (89%). As compared to the Caucasians and Hispanics from Puerto Rico, African American and Hispanic (Texas) patients are younger, less likely to be married/living together (75% and 61% vs. 32% and 53%, respectively), have less years of formal education (14 and 15 vs. 13 and 11 years, respectively) and are more likely to live under the poverty line (14% and 29% vs. 44% and 43%, respectively). Hispanics from Puerto Rico have the largest proportion of
Admixture
As the LUMINA cohort enters its 11th year, how close are we to dissect out the role that genetic/biologic and socioeconomic factors exert in the expression and the ultimate outcome of SLE? It is clear, overall, that African Americans and Hispanics (from Texas) have a more serious disease and tend to experience worse outcomes as compared to Caucasians and Hispanics from Puerto Rico. Although there are immunogenetic differences between these four groups of patients, there are also clear
Conclusions
The LUMINA cohort represents an important and valuable scientific resource with great possibilities of growth. Patients are followed at three different centers in the United States and the study includes now a diverse group of patients from the major ethnic groups inhabiting this country (Hispanics from Texas and Puerto Rico, African Americans and Caucasians).
This multiethnic cohort has given the LUMINA investigators the unique opportunity to study a great variety of factors and their influence
Acknowledgements
Supported by NIAMS Grants #R01-AR42503 and #R01-AR42503 2, GCRC Grants #M01-RR00032 2 and #M01-RR02558 2, and the Mary Kirkland Scholar Award Program.
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- 1
On behalf of the LUMINA study group.