Scleroderma Outcomes Often Worse for Blacks, US Study Finds
Black patients with scleroderma are at higher risk of mortality and serious complications such as interstitial lung disease than those of other racial or ethnic groups, a single-center U.S. study found.
These findings may foster early monitoring of these patients as well as greater awareness among clinicians, researchers said.
The study, “Disease Characteristics and Social Determinants in African Americans with Systemic Sclerosis: A Single Center Experience,” was presented at ACR Convergence 2021, the American College of Rheumatology’s annual meeting.
Studies indicate that scleroderma (also known as systemic sclerosis) affects women more than men, and that Black patients experience poor outcomes more commonly than those of other races or ethnicities. Researchers at the Medical University of South Carolina intended to know more by analyzing 16 years of registry data, focusing on factors that may explain why Black patients have worse outcomes.
“We decided to undertake this project because it had previously been shown Black patients experience other autoimmune diseases such as myasthenia gravis (a chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle) and systemic lupus erythematosus (SLE) differently than non-Black patients, and they typically have more severe clinical characteristics,” Sarah M. Compton, MD, a rheumatologist and the study’s first author, said in a press release.
The study looked at 372 patients; almost 80% were females and 37.9% were Black.
Results showed that Black patients had scleroderma at a significantly younger age than the remaining patients (41.8 vs. 48.9 years). A similar difference showed that females developed the condition at a younger age than males (45.4 vs. 50.2 years).
Additionally, when comparing outcomes for diffuse cutaneous systemic sclerosis, interstitial lung disease, and restrictive lung disease (a decrease in the total volume of air that the lungs are able to hold), all serious complications in scleroderma, the researchers found that Blacks were at a significantly greater risk as compared with non-Blacks.
Even when controlling for disease duration, they found the risk for mortality, diffuse cutaneous disease (a more severe scleroderma subtype), pulmonary hypertension, and interstitial lung disease all remained significantly higher for Black patients.
“This means that being Black was associated with worsened outcomes no matter how long the patient had systemic sclerosis. This may affect how clinicians care for their Black patients with systemic sclerosis, as well as possibly encouraging them to involve other specialists earlier,” Compton said.
In addition, men more frequently had diffuse lung disease, difficulty swallowing, and restrictive lung disease compared with women.
Blacks were also significantly less likely to have private health insurance (43.8% versus 66.8% of non-Blacks) or graduate high school (89.7% versus 96.4%) than were other patients in this study.
Compton’s team intends to interview patients to understand further how social determinants such as insurance coverage may be affecting their health.
“We felt this project was important to explore because it will alert the clinician to be more aware of worsened clinical characteristics in Black patients. Earlier and more severe disease characteristics may mean sooner follow-up and more diagnostic testing to screen earlier for processes like interstitial lung disease,” the scientist added.
“Further investigation into the multifactorial causes for this disparity is needed in order to identify strategies to reduce them,” the team concluded.