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Systemic lupus erythematosus in a multi-ethnic cohort (LUMINA): contributions of admixture and socioeconomic status to renal involvement

Departments of Medicine (Division of Clinical Immunology and Rheumatology), Epidemiology, Biostatistics (Section of Statistical Genetics) and Surgery (Section of Trauma, Burns and Critical Care), Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA, graciela.alarcon{at}ccc.uab.edu

H M Bastian

Departments of Medicine (Division of Clinical Immunology and Rheumatology), Epidemiology, Biostatistics (Section of Statistical Genetics) and Surgery (Section of Trauma, Burns and Critical Care), Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA

T M Beasley

Departments of Medicine (Division of Clinical Immunology and Rheumatology), Epidemiology, Biostatistics (Section of Statistical Genetics) and Surgery (Section of Trauma, Burns and Critical Care), Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA

J M Roseman

Departments of Medicine (Division of Clinical Immunology and Rheumatology), Epidemiology, Biostatistics (Section of Statistical Genetics) and Surgery (Section of Trauma, Burns and Critical Care), Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA

F K Tan

Department of Medicine (Division of Rheumatology), The University of Texas Health Science Center at Houston, Houston, TX, USA

B J Fessler

Departments of Medicine (Division of Clinical Immunology and Rheumatology), Epidemiology, Biostatistics (Section of Statistical Genetics) and Surgery (Section of Trauma, Burns and Critical Care), Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA

L M Vilá

Departments of Medicine (Division of Rheumatology), The University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA

G McGwin

Departments of Medicine (Division of Clinical Immunology and Rheumatology), Epidemiology, Biostatistics (Section of Statistical Genetics) and Surgery (Section of Trauma, Burns and Critical Care), Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA

J D Reveille

Department of Medicine (Division of Rheumatology), The University of Texas Health Science Center at Houston, Houston, TX, USA

LUMINA Study Group

Renal involvement in systemic lupus erythematosus (SLE) is more frequent in minorities. We examined whether genetic or socioeconomic status (SES) explain these disparities in a large multiethnic (Hispanics from Texas and Puerto Rico, African Americans and Caucasians) SLE cohort. Renal involvement was defined as WHO Class II-V and/or proteinuria (>0.5 g/24 h or 3+) attributable to SLE and/or abnormal urinary sediment, proteinuria 2+, elevated serum creatinine/decreased creatinine clearance twice, 6 months apart present any time over the course of the disease. Ancestry informative markers (AIMS) were used to define the admixture proportions in each patient and group. Logistic regression models were examined to determine the percentage variance (R ²) in renal involvement related to ethnicity that is explained by socio-economic status (SES) and admixture (adjusting for age, gender and disease duration, basic model). Four-hundred and fifty-nine (out of 575) patients were included; renal involvement occurred in 44.6% Texas Hispanics, 11.3% Puerto Rico Hispanics, 45.8% African Americans, 18.3% Caucasians. SES accounted for 14.5% of the variance due to ethnicity (after adjusting for basic model variables), admixture 36.8% and both, 12.2%; 45.9% of the variance remained unexplained. Alternative models for decreased glomerula filtration rate and end-stage renal disease were comparable in the distribution of the explanatory variables. Our data indicate that genetic factors appear to be more important than SES in explaining the ethnic disparities in the occurrence of renal involvement.

Key Words: lupus nephritis • admixture • ethnicity • cohort

Lupus, Vol. 15, No. 1, 26-31 (2006)
DOI: 10.1191/0961203306lu2260oa


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