1059: Assessing the Relationship Between Multidimensional Area Level Indicators and Lupus Disease Activity in Children

Background/Purpose: Recent research suggests that multidimensional area-level indicators, including the Social Vulnerability Index (SVI), Area Deprivation Index (ADI) and Childhood Opportunity Index (COI), associate with childhood-onset systemic lupus erythematosus (cSLE) outcomes in primarily urban populations. However, to date, there are no studies that have assessed the utility of multidimensional area level indicators in children with cSLE living in rural areas. The goal of this study is to estimate relationships between neighborhood conditions and disease activity in children with cSLE who live in a mixed rural and urban setting. We hypothesized that patients with cSLE living in areas with higher social vulnerability and area-level deprivation have increased lupus activity.

Methods: We retrospectively evaluated electronic health record data for pediatric patients with cSLE across three pediatric rheumatology clinics at a single center between January 1, 2020 and December 31, 2024. We included patients with a diagnosis of cSLE before 18 years of age, a residential address within South Carolina, and excluded PO box addresses. Chart reviews were conducted to collect demographic data and addresses were linked to census tract-level indicators, including ADI, SVI and COI, ranked at state and national levels. We assessed each patient’s SLEDAI-2K score at their first clinic or hospital encounter associated with a SLE diagnosis.

Results: Baseline characteristics have been established for a cohort of 85 children with cSLE. The majority of patients identified as Black 65 (79%), followed by White 11 (13%), Latino/a 6 (6%), Asian 1 (1%), and Other 1 (1%). The cohort was predominantly female (87.1%), with a mean age at diagnosis of 13.0 years (range: 6–17). The mean SLEDAI-2K at the initial encounter was 14.4 (range: 0-38). Most participants (40%) lived in areas with low state-ranked SVI scores (mean 0.42), with no significant correlation with initial SLEDAI-2K (R= 0.014). National SVI levels were higher, with most patients classified in medium-to-high (51.2%) SVI category (mean 0.69), with no significant correlation with initial disease activity (R = 0.0223). Similarly, neither state nor national ADI rank correlated with initial SLEDAI-2K (R = 0.106 and 0.0905, respectively). Most patients lived in areas with very low (35.3%) state-ranked child opportunity and very low (38.8%) nationally ranked opportunity. Again, no significant correlation was found between COI and initial disease activity (R = 0.067 and 0.050, respectively).

Conclusion: In a mixed rural and urban population, we did not observe significant associations between area-level measures of social vulnerability, area deprivation or childhood opportunity (COI) and lupus disease activity, as measured by SLEDAI-2K score at initial presentation to rheumatology care. Despite the cohort’s residence in predominantly deprived and low-opportunity areas, these indicators did not appear to predict lupus severity at first presentation to care. These findings highlight limitations in the use of available area-level indicators to explain pediatric lupus outcomes in mixed rural and urban areas.