BACKGROUND Systemic lupus erythematous (SLE) disproportionately impacts patients of color and socioeconomically disadvantaged patients. Similar disparities in HIV were reduced through a World Health Organization-endorsed Care Continuum strategy targeting "retention in care," defined as having at least two annual visits or viral load lab tests. Using similar definitions, this study aimed to examine predictors of lupus retention in care, to develop an SLE Care Continuum and inform interventions to reduce disparities. We hypothesized that Black patients and those residing in disadvantaged neighborhoods would have lower retention in care. METHODS Abstractors manually validated 545 potential adult cases with SLE codes in 2013-2014 using 1997 American College of Rheumatology (ACR) or 2012 Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) criteria. We identified 397 SLE patients who met ACR or SLICC criteria for definite lupus, had at least one baseline rheumatology visit, and were alive through 2015. Retention in care was defined as having two ambulatory rheumatology visits or SLE labs (e.g., complement tests) during the outcome year 2015, analogous to HIV retention definitions. Explanatory variables included age, sex, race, ethnicity, smoking status, neighborhood area deprivation index (ADI), number of SLE criteria, and nephritis. We used multivariable logistic regression to test our hypothesis and model predictors of SLE retention in care. RESULTS Among 397 SLE patients, 91% were female, 56% White, 39% Black, and 5% Hispanic. Notably, 51% of Black versus 5% of White SLE patients resided in the most disadvantaged ADI neighborhood quartile. Overall, 60% met visit-defined retention and 27% met complement lab-defined retention in 2015. Retention was 59% lower for patients in the most disadvantaged neighborhood quartile (adjusted OR 0.41, CI 0.18, 0.93). No statistical difference was seen based on age, sex, race, or ethnicity. More SLE criteria and non-smoking predicted greater retention. CONCLUSIONS Disadvantaged neighborhood residence was the strongest factor predicting poor SLE retention in care. Future interventions could geo-target disadvantaged neighborhoods and design retention programs with vulnerable populations to improve retention in care and reduce SLE outcome disparities.

中文翻译：

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调查狼疮在护理中的保留情况，以为减少差异提供干预措施：一项观察性队列研究。

背景技术系统性红斑狼疮（SLE）过度影响有色患者和社会经济弱势患者。通过世界卫生组织认可的“护理连续性”策略，减少了类似的艾滋病毒差异，该策略的目标是“保持护理”，即至少每年两次访问或进行病毒载量实验室测试。本研究使用相似的定义，旨在检查狼疮在护理中的保留的预测因素，以开发SLE护理连续体并为减少差异提供干预措施。我们假设黑人患者和居住在弱势社区的患者在医疗方面的保留率较低。方法摘要作者使用1997年美国风湿病学会（ACR）或2012年系统性红斑狼疮国际合作诊所（SLICC）标准手动验证了545例潜在的SLE代码成人病例。我们确定了397例SLE患者，它们符合确定性狼疮的ACR或SLICC标准，至少进行了一次风湿病基线访视，并且在2015年之前还活着。保留护理的定义是，在治疗期间进行了两次非卧床风湿病访视或SLE实验室（例如补体检查）类似于艾滋病毒保留定义的2015年成果年。解释性变量包括年龄，性别，种族，种族，吸烟状况，邻域剥夺指数（ADI），SLE标准数和肾炎。我们使用多变量logistic回归来检验我们的假设和SLE保留在护理中的模型预测因子。结果397例SLE患者中，女性占91％，白人占56％，黑人占39％，西班牙裔占5％。值得注意的是，黑人SLE患者中有51％，白人SLE患者中有5％，处在最不利的ADI邻区四分位数中。总体而言，2015年达到访视定义的保留率的比例为60％，补充实验室定义的保留率的比例为27％。在处境最不利的四分位数中，患者的保留率降低了59％（调整后的OR 0.41，CI 0.18、0.93）。没有基于年龄，性别，种族或种族的统计学差异。更多的SLE标准和不吸烟预示着更大的保留率。结论弱势邻里居住是预测SLE护理不良的最强因素。未来的干预措施可以针对弱势社区，并针对弱势人群设计保留计划，以提高对医疗服务的保留率并减少SLE结果差异。