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Article ; Online: Introduction to the Special Theme Issue: Heath Disparities and Health Equity in the Rheumatic Diseases.

Allen, Kelli D / Lim, S Sam

2022 Volume 75, Issue 1, Page(s) 1–2

MeSH term(s)	Humans ; Health Equity ; Rheumatic Diseases/diagnosis ; Rheumatic Diseases/therapy ; Health Status Disparities ; Healthcare Disparities
Language	English
Publishing date	2022-12-07
Publishing country	United States
Document type	Editorial
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.25062
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Article ; Online: The impact of social determinants of health on the presentation, management and outcomes of systemic lupus erythematosus.

Williams, Jessica N / Drenkard, Cristina / Lim, S Sam

Rheumatology (Oxford, England)

2023 Volume 62, Issue Suppl 1, Page(s) i10–i14

Abstract: Disparities in SLE rates and outcomes have been attributed to genetic and hormonal factors, cigarette smoking and environmental pollutants. However, a growing body of research indicates that social determinants of health (SDH) also have substantial ... ...

Abstract	Disparities in SLE rates and outcomes have been attributed to genetic and hormonal factors, cigarette smoking and environmental pollutants. However, a growing body of research indicates that social determinants of health (SDH) also have substantial impact on the disparities that characterize SLE. According to the World Health Organization, SDH are defined as 'the conditions in which people are born, grow, work, live, and age', account for 30-55% of health outcomes, and adversely impact health outcomes among those of low socioeconomic status and stigmatized racial/ethnic groups. We reviewed the impact of key SDH on SLE presentation, management and outcomes, including income, education, neighbourhood factors, healthcare access, discrimination and social support. We found that adverse SDH conditions may lead to more severe SLE with increased morbidity and mortality, and that SDH affect SLE management by dictating the most feasible monitoring and treatment plan for each individual patient based on his or her specific life circumstances (for example, based on health insurance status, distance to nearest provider and/or drug affordability). SDH also have a significant impact on SLE outcomes, with worse disease and psychosocial outcomes associated with lower income level, lower educational attainment, disadvantaged neighbourhoods, lack of health insurance or public health insurance in the USA, travel burden to nearest provider, anti-Black racism and lower social support. Future efforts to improve the management and outcomes of patients with SLE must combat the societal, economic and political forces that perpetuate these inequities.
MeSH term(s)	Humans ; Educational Status ; Lupus Erythematosus, Systemic/epidemiology ; Lupus Erythematosus, Systemic/therapy ; Lupus Erythematosus, Systemic/complications ; Racial Groups ; Social Determinants of Health
Language	English
Publishing date	2023-04-12
Publishing country	England
Document type	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1464822-2
ISSN	1462-0332 ; 1462-0324
ISSN (online)	1462-0332
ISSN	1462-0324
DOI	10.1093/rheumatology/keac613
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Article ; Online: Introduction to the Special Theme Issue: COVID-19 & Rheumatology: Emerging Insights and Impacts.

Brady, Teresa J / Lim, S Sam / Allen, Kelli D

Arthritis care & research

2022 Volume 76, Issue 1, Page(s) 1–3

MeSH term(s)	Humans ; COVID-19 ; Rheumatology ; SARS-CoV-2
Language	English
Publishing date	2022-03-01
Publishing country	United States
Document type	Editorial
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.25263
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Article ; Online: Understanding Lupus Disparities Through a Social Determinants of Health Framework: The Georgians Organized Against Lupus Research Cohort.

Lim, S Sam / Drenkard, Cristina

Rheumatic diseases clinics of North America

2020 Volume 46, Issue 4, Page(s) 613–621

Abstract: Limitations in the ability to assemble large cohorts of patients with lupus from previously underrepresented groups have inhibited better understanding of many unanswered questions. The Georgians Organized Against Lupus (GOAL) Research Cohort is designed ...

Abstract	Limitations in the ability to assemble large cohorts of patients with lupus from previously underrepresented groups have inhibited better understanding of many unanswered questions. The Georgians Organized Against Lupus (GOAL) Research Cohort is designed to overcome many of these limitations and is a rich and diverse repository of clinical, biological, sociodemographic, psychosocial, and health services data, and biologic material. Studies with the GOAL cohort will improve the understanding of how various factors interact and may lead to interventions on an individual and systems and societal level and help to mitigate the significant disparities that continue to exist in lupus.
MeSH term(s)	Health Services Accessibility ; Healthcare Disparities ; Humans ; Lupus Erythematosus, Systemic/epidemiology ; Social Determinants of Health
Language	English
Publishing date	2020-09-09
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Review
ZDB-ID	92118-x
ISSN	1558-3163 ; 0889-857X
ISSN (online)	1558-3163
ISSN	0889-857X
DOI	10.1016/j.rdc.2020.07.002
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Article ; Online: Update on lupus epidemiology: advancing health disparities research through the study of minority populations.

Drenkard, Cristina / Lim, S Sam

Current opinion in rheumatology

2019 Volume 31, Issue 6, Page(s) 689–696

Abstract: Purpose of review: The current review focuses on recent population-based studies that have examined the burden of lupus, disease outcomes, and gaps in quality of care, with an emphasis in research addressing health disparities.: Recent findings: The ... ...

Abstract	Purpose of review: The current review focuses on recent population-based studies that have examined the burden of lupus, disease outcomes, and gaps in quality of care, with an emphasis in research addressing health disparities. Recent findings: The Centers for Disease Control and Prevention National Lupus Registries underscored higher susceptibility of both systemic lupus erythematosus (SLE) and primary cutaneous lupus among people of color, compared with whites. Not only does SLE disproportionately strike people from racial and ethnic minorities, those individuals are also at increased risk of developing severe manifestations following SLE diagnosis. Mortality is higher and death occurs at a younger age among blacks, compared with whites. Furthermore, ongoing Centers for Disease Control and Prevention-supported population-based lupus cohorts, along with research by other groups, have provided new insight into the role of social determinants on outcomes and opportunities to improve care in diverse lupus populations. Summary: While descriptive epidemiological efforts have been critical to providing more accurate estimates of the burden and mortality of lupus across diverse demographic groups, emerging research suggests a significant influence of psychosocial and healthcare system factors on disease outcomes. These current efforts represent important steps toward the development of clinical and public health interventions aimed at eliminating health disparities in lupus populations.
MeSH term(s)	Global Health ; Healthcare Disparities ; Humans ; Incidence ; Lupus Erythematosus, Systemic/epidemiology ; Minority Groups ; Public Health ; Registries
Language	English
Publishing date	2019-08-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S. ; Review
ZDB-ID	1045317-9
ISSN	1531-6963 ; 1040-8711
ISSN (online)	1531-6963
ISSN	1040-8711
DOI	10.1097/BOR.0000000000000646
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Article: Comparison of cognitive performance measures in individuals with systemic lupus erythematosus.

Plantinga, Laura / Yazdany, Jinoos / Bowling, C Barrett / Dunlop-Thomas, Charmayne / Hoge, Courtney / Pearce, Brad D / Lim, S Sam / Katz, Patricia

Lupus science & medicine

2024 Volume 11, Issue 1

Abstract: Objective: Cognitive impairment is a common complaint in SLE, but approaches to measuring cognitive performance objectively vary. Leveraging data collected in a population-based cohort of individuals with validated SLE, we compared performance and ... ...

Abstract	Objective: Cognitive impairment is a common complaint in SLE, but approaches to measuring cognitive performance objectively vary. Leveraging data collected in a population-based cohort of individuals with validated SLE, we compared performance and potential impairment across multiple measures of cognition. Methods: During a single study visit (October 2019-May 2022), times to complete the Trail Making Test B (TMTB; N=423) were recorded; potential impairment was defined as an age-corrected and education-corrected T-score <35 (>1.5 SD longer than the normative time). A clock drawing assessment (CLOX; N=435) with two parts (free clock draw (CLOX1) and copy (CLOX2)) was also performed (score range: 0-15; higher scores=better performance); potential impairment was defined as CLOX1 <10 or CLOX2 <12. Fluid cognition (N=199; in-person visits only) was measured via the National Institutes of Health (NIH) Toolbox Fluid Cognition Battery and expressed as age-corrected standard scores; potential impairment was defined by a score <77.5 (>1.5 SD lower the normative score). Results: Participants (mean age 46 years; 92% female; 82% black) had a median (IQR) TMTB time of 96 (76-130) s; median (IQR) CLOX1 and CLOX2 scores of 12 (10-13) and 14 (13-15); and a mean (SD) fluid cognition standard score of 87.2 (15.6). TMTB time and fluid cognition score (ρ=-0.53, p<0.001) were the most highly intercorrelated measures. Overall, 65%, 55% and 28% were potentially impaired by the TMTB test, CLOX task and NIH Toolbox Fluid Cognition Battery, respectively. While there was overlap in potential impairment between TMTB and CLOX, more than half (58%) had impairment by only one of these assessments. Few (2%) had impairment in fluid cognition only. Conclusion: The TMTB, CLOX and NIH Fluid Cognition Battery each provided unique and potentially important information about cognitive performance in our SLE cohort. Future studies are needed to validate these measures in SLE and explore interventions that maintain or improve cognitive performance in this population.
MeSH term(s)	Humans ; Female ; Middle Aged ; Male ; Lupus Erythematosus, Systemic/complications ; Lupus Erythematosus, Systemic/diagnosis ; Cognition Disorders/diagnosis ; Cognition Disorders/etiology ; Cognition
Language	English
Publishing date	2024-04-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2779620-6
ISSN	2053-8790
ISSN	2053-8790
DOI	10.1136/lupus-2024-001151
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Article ; Online: Implementing a Staff-Led Smoking Cessation Intervention in a Diverse Safety-Net Rheumatology Clinic: a pre-post scalability study in a low resource setting.

Brandt, Jennifer / Ramly, Edmond / Lim, S Sam / Bao, Gaobin / Messina, Monica L / Piper, Megan E / Bartels, Christie M

Arthritis care & research

2024

Abstract: Objectives: Quit Connect (QC), our specialty clinic smoking cessation intervention, supports clinic staff to check, advise, and connect willing patients to a state quit line or class. QC improved tobacco screening and quit line referrals 26-fold in a ... ...

Abstract	Objectives: Quit Connect (QC), our specialty clinic smoking cessation intervention, supports clinic staff to check, advise, and connect willing patients to a state quit line or class. QC improved tobacco screening and quit line referrals 26-fold in a predominantly White academic healthcare system population. Implementing QC includes education, electronic health record (EHR) reminders, and periodic audit feedback. This study tested QC's feasibility and impact in a safety-net rheumatology clinic with a predominantly Black population. Methods: In this pre-post study, adult rheumatology visits were analyzed 12 months pre- through 18 months post-QC intervention (November 2019 - November 2021, omitting COVID-19 peak April-Nov 2020). EHR data compared process and clinical outcomes, including offers, referrals to resources, completed referrals, and documented cessation. Clinic staff engaged in pre-post focus groups and questionnaires regarding intervention feasibility and acceptability. Cost effectiveness was also assessed. Results: Visit-level patients who smoked were 89.8% Black and 69.5% women (n=550). Pre-intervention, clinic staff rarely asked patients about readiness to cut back smoking (< 10% assessment). Post QC intervention, staff assessed quit readiness in 31.8% of visits with patients who smoked (vs 8.1% pre); 58.9% of these endorsed readiness to cut back or quit. Of 102 accepting cessation services, 37% (n = 17) of those reached set a quit date. Staff found the intervention feasible and acceptable. Each quit attempt cost approximately $4-10. Conclusions: In a safety-net rheumatology clinic with a predominantly Black population, QC improved tobacco screening, readiness-to-quit assessment, and referrals and was also feasible and cost-effective.
Language	English
Publishing date	2024-04-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.25349
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Article ; Online: Physical Performance in a Diverse, Population-Based Cohort of Individuals With Systemic Lupus Erythematosus.

Plantinga, Laura C / Bowling, C Barrett / Hoge, Courtney / Dunlop-Thomas, Charmayne / Pearce, Bradley D / Lim, S Sam / Drenkard, Cristina

Arthritis care & research

2024 Volume 76, Issue 4, Page(s) 517–525

Abstract: Objective: To report the burden and correlates of poor physical performance in a diverse cohort of individuals with systemic lupus erythematosus (SLE).: Methods: In this single-visit study of 446 individuals with SLE from a population-based ... ...

Abstract	Objective: To report the burden and correlates of poor physical performance in a diverse cohort of individuals with systemic lupus erythematosus (SLE). Methods: In this single-visit study of 446 individuals with SLE from a population-based metropolitan Atlanta cohort, we measured physical performance via the Short Physical Performance Battery (score range 0-12; intermediate-low [<10] vs high [≥10]). We also collected demographic, clinical, and psychosocial variables and examined the associations (adjusted odds ratios [aORs]) of intermediate-low versus high physical performance with these characteristics via multivariable logistic regression. Results: We found that more than half (59.6%) of our participants had poorer (intermediate-low) overall physical performance. Only 7% of the cohort received the maximum score on the lower body strength task versus 90% and 76% receiving the maximum scores on balance and gait speed tasks. Current employment status (aOR 0.69, 95% confidence interval [CI] 0.45-1.05) and higher cognitive functioning (aOR 0.57, 95% CI 0.42-0.77) were strongly associated with lower odds of intermediate-low physical performance. Higher body mass index (aOR 1.25, 95% CI 1.01-1.56), disease activity (aOR 1.59, 95% CI 1.27-1.98), and disease burden (aOR 1.38, 95% CI 1.08-1.77) were associated with poorer performance, as were higher depressive symptoms, perceived stress scores, and lower educational attainment (not statistically significant). Conclusion: In our population-based, primarily Black cohort, we found that individuals with SLE commonly had poor physical performance. We identified both SLE- and non-SLE-specific factors that could help clinicians identify those most at risk for poor physical performance and intervene to improve, maintain, and support physical performance among those with SLE.
MeSH term(s)	Humans ; Educational Status ; Lupus Erythematosus, Systemic/diagnosis ; Lupus Erythematosus, Systemic/epidemiology ; Lupus Erythematosus, Systemic/complications ; Physical Functional Performance ; Cost of Illness ; Cross-Sectional Studies
Language	English
Publishing date	2024-01-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.25266
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Article: The Burden of Living With Cutaneous Lupus Erythematosus.

Drenkard, Cristina / Barbour, Kamil E / Greenlund, Kurt J / Lim, S Sam

Frontiers in medicine

2022 Volume 9, Page(s) 897987

Abstract: Cutaneous lupus erythematosus (CLE) is a group of heterogeneous autoimmune disorders primarily affecting the skin. Patients with these conditions are mostly young women when they become sick and often suffer from recurrent skin symptoms or longstanding ... ...

Abstract	Cutaneous lupus erythematosus (CLE) is a group of heterogeneous autoimmune disorders primarily affecting the skin. Patients with these conditions are mostly young women when they become sick and often suffer from recurrent skin symptoms or longstanding changes in their physical appearance. CLE disorders lead to different levels of morbidity and can impact profoundly patients' quality of life, particularly in the psychological and social health domains. This review provides a summary of recent research investigating the psychosocial burden of living with CLE and the intersect amongst the disease characteristics, patient factors, and social determinants of health. Furthermore, this review provides insight into patient care and research needs that remain unmet to improve the quality of life of patients living with CLE.
Language	English
Publishing date	2022-08-08
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2022.897987
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Article ; Online: Factors Associated With the Initiation and Retention of Patients With Lupus in the Chronic Disease Self-Management Program.

Falasinnu, Titilola / Bao, Gaobin / Brady, Teresa J / Lim, S Sam / Drenkard, Cristina

Arthritis care & research

2023 Volume 75, Issue 3, Page(s) 519–528

Abstract: Objective: The Chronic Disease Self-Management Program (CDSMP) is designed to enhance patients' self-efficacy and skills to manage their chronic illness. There is compelling evidence for the benefits of the CDSMP among patients with systemic lupus ... ...

Abstract	Objective: The Chronic Disease Self-Management Program (CDSMP) is designed to enhance patients' self-efficacy and skills to manage their chronic illness. There is compelling evidence for the benefits of the CDSMP among patients with systemic lupus erythematosus (SLE); however, little is known about predictors of participation among Black women with SLE. We examined factors associated with CDSMP initiation and completion in this population. Methods: We studied 228 Black women with SLE who consented to attend a CDSMP workshop. We used logistic regression to calculate unadjusted and adjusted odds ratios (ORs) for being a CDSMP initiator (a participant registered into the CDSMP who attended at least 1 of the first 2 weekly classes) and a CDSMP completer (a participant who completed at least 4 of 6 weekly classes). Results: The majority of participants were CDSMP initiators (74% [n = 168]). Of those, 126 (75%) were CDSMP completers. Older age (adjusted OR [OR Conclusion: Our findings suggest that young Black women with SLE face barriers to attend and complete in-person CDSMP workshops, possibly in relation to work and child care demands.
MeSH term(s)	Humans ; Female ; Self-Management ; Lupus Erythematosus, Systemic/diagnosis ; Lupus Erythematosus, Systemic/epidemiology ; Lupus Erythematosus, Systemic/therapy ; Chronic Disease ; Self Efficacy ; Self Care
Language	English
Publishing date	2023-01-10
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.24811
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