Racial and ethnic minorities experience higher rates of a variety of health concerns than other populations. For example, the National Public Health Association reports that in the year 2000, nearly 8 percent of Caucasians were considered to be in fair or poor health compared to nearly 13 percent of Latinos, nearly 14 percent of African Americans, and more than 17 percent of Native Americans.

In addition to ethnicity (race, cultural values, beliefs, and practices), some potential reasons for racial health disparities include communication barriers, lack of access to care, lower income levels, and lack of insurance.

Facts About Gender and Racial Disparities in Lupus

• Lupus targets women and minorities.
• Lupus is estimated to affect 1 to 1.5 million Americans, 90 percent of whom are women.
• African-American women are three times more likely to get lupus than Caucasian women and to suffer worse symptoms. According to the National Institutes of Health (NIH), as many as one in every 250 African-American women has lupus.
• Latino, Asian, and Native American women have an increased incidence of lupus. In fact, lupus is twice as prevalent among Asian-American and Latino women as it is among Caucasian women.
• The Centers for Disease Control and Prevention (CDC) reports that death rates from lupus are more than five times higher for women than for men and more than three times higher for African Americans than for Caucasians.
• Between 1979 and 1998, death rates from lupus increased nearly 70 percent among African-American women between the ages of 45 and 64 years.

Ethnicity, the Major Determinant of Lupus Progression

The largest multi-ethnic, multi-regional, and multi-institutional study of lupus, called Lupus in Minorities: Nature Versus Nurture (LUMINA), has provided insight into the extent of disease, and the role of nature (genetics) or nurture (lifestyle) in lupus among Latino and African-American populations. The study tracked death, damage, disability, and disease activity.

LUMINA began in 1993, and was spearheaded by investigators from three institutions: Graciela S. Alarcon, MD, MPH, from the University of Alabama, John D. Reveille, MD of the University of Texas Health Science Center-Houston, Jeffrey R. Lisse, MD, of the University of Texas Medical Branch-Galveston, and more recently, Luis M. Vilá, MD of the University of Puerto Rico School of Medicine.

The researchers have published numerous papers reporting study findings on the relative contribution of genetic and socioeconomic factors on the course and outcome of lupus in Latinos, African Americans, and Caucasians.

LUMINA Findings

• African-American and Latino lupus patients tend to develop lupus earlier in life, experience greater disease activity such as kidney problems, and have overall more severe disease than Caucasian patients.
• Latino women had a poorer prognosis overall than Caucasian women, were more likely to have kidney involvement and damage, and showed a more rapid rate of kidney failure.
• African-American patients had a higher frequency of neurological problems such as seizures, hemorrhage, and stroke while Latinos experienced a higher level of cardiac disease.
• Genetic and ethnic factors appear to be more important than socioeconomic determinants in influencing disease activity and certain organ manifestations at disease onset and presentation. The results also suggest that there are probably other genetic factors affecting the presentation of the disease in the African-American and Latino communities.

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