607 Differences in social support among African American Women with and without systemic lupus erythematosus (SLE)

Introduction SLE disproportionately affects African American women. Social support may have a positive impact in SLE and as such could potentially reduce disease burden. However, the relationship between social support and SLE disease outcomes has not been thoroughly investigated in African American women with SLE. The goal of this study is to evaluate the relationship between social support and disease outcomes using data from validated participant questionnaires. Methods Adult self-reported African American women meeting the 1997 ACR revised or 2012 SLICC classification criteria for SLE, or controls without any known connective tissue disease, were recruited for this study. Social support was measured using the validated Medical Outcomes Study-Social Support (MOS-SS) survey. The physician assessed SLE Disease Activity Index (SLEDAI) and the patient reported Brief Index of Lupus Damage (BILD) were used to assess SLE severity. Associations between SLE status and overall MOS-SS score as well as the MOS-SS support domains were analyzed using a series of Wilcoxon rank-sum tests. Hodges-Lehmann estimation was used to calculate the confidence intervals for the difference in medians. Among participants with SLE, associations between MOS-SS score with disease activity (SLEDAI) and with patient reported organ damage (BILD) were evaluated using Spearman's rank correlation. All analyses were performed on RStudio v4.0.3. Results This preliminary study was comprised of 70 patients with SLE and 60 healthy controls, all self-identified African American females. Among those with SLE, the mean (±SD) age of diagnosis was 30±10 years and disease duration at the study visit was 19±8 years. Although many sociodemographic and behavioral characteristics were similar in patients and controls (e.g., 75% had a college degree or higher, 55% owned a home, 90% rarely or never drank, and 80% exercised at least weekly), many other (e.g., multiple comorbidities) differed between the groups. SLE cases had significantly lower overall MOS-SS scores compared to healthy controls (p = 0.026). When considering the MOS-SS support domains, SLE patients had significantly lower scores for the emotional/informational support, affectionate support, and positive social interaction domains (p ≤ 0.05 for all three groups). No notable difference between SLE patients and healthy controls was found for the tangible support domain. Among patients with SLE, a significant association was found between overall MOS-SS score and physician reported disease activity (using SLEDAI), such that SLE patients with higher SLEDAI scores had lower MOS-SS scores (ρ = -0.36, p = 0.0003). No significant association was found between patient reported organ damage (BILD score) and overall MOS-SS score (p = 0.48). Conclusion This study found significant differences in the overall MOS-SS score between patients with SLE and healthy controls and furthermore, the groups differed for the emotional/informational support, affectionate support, and positive social interaction domains. Among the patients with SLE, a significant inverse correlation between SLEDAI total score and overall MOS-SS score was also observed. The potential clinical relevance of these findings suggests that targeted interventions to improve social support could potentially improve SLE outcomes, though further research is needed.