Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions. 1. Introduction Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that is characterized by autoantibody production and multiple organ system involvement, including a high prevalence of polyarthritis [1–4]. In the United States, over the past four decades, SLE incidence has increased and claims one of the highest mortality rates among rheumatic diseases [5, 6]. SLE incidence, prevalence, morbidity, and mortality are all much higher among minorities than whites in the United States. SLE incidence rates among African American women are 3 to 4 times higher than white women, while men have much lower rates than women in general [7], and Hispanics, Asians, and Native Americans are also more likely to develop lupus than non-Hispanic Whites [8, 9]. The overall spectrum of SLE clinical presentation is similar across different ethnic groups, but there appears to be some differences in the autoantibody profile, frequency of certain specific disease complications, and the severity and overall prognosis of the condition [10]. For example, there is cumulative evidence that lupus nephritis (LN)/renal disease is more prevalent in African and Hispanic Americans, as well as Chinese and other