Document resource
Objectives Systemic lupus erythematosus (SLE) is a complex autoimmune disease with heterogeneous clinical manifestations. Evidence from high-income countries suggests that socioeconomic status (SES) and environmental factors influence SLE outcomes, yet data from Latin America remain limited. The objective of this research was to evaluate, across three levels (individual, regional, national), whether socioeconomic and environmental factors impact the clinical presentation of SLE in the GLADEL 2.0 cohort.Methods We analyzed data from 1,083 patients with SLE enrolled in the GLADEL 2.0 cohort across 10 Latin American countries. All patients fulfilled the 1982/1997 American College of Rheumatology (ACR) or 2012 Systemic Lupus International Cooperating Clinics (SLICC) classification criteria. Clinical outcomes were disease activity (SLEDAI-2K), organ involvement (renal, hematologic, cutaneous, musculoskeletal), and organ damage (SLICC/ACR damage index; SDI). Variables were structured into three levels: Level 1 (individual), Level 2 (state/province), Level 3 (national). Multilevel analyses included sociodemographic variables, environmental exposure to air pollutants (PM2.5, PM10, NO2), and contextual indicators (income, unemployment, distribution of income or wealth through the Gini index, CO2 emissions). Statistical analysis included cluster analysis (Ward’s method) and principal component analysis (PCA).Results Five clusters emerged based on socioeconomic and environmental determinants. Cluster two (urban, high-income, low inequality) exhibited low damage (SDI [mean±SD] 0.66±0.9) and high disease activity (SLEDAI [mean±SD] 13.0±9.2). Conversely, Cluster four (middle-low SES, high inequality, high NO2 exposure) demonstrated high disease impact (SDI [mean±SD] 1.06±1.4) and greatest work productivity loss (36.1%). Cluster three (low-income, low pollution) presented the highest accumulated damage (mean SDI [mean±SD] 1.73±1.95). Environmental exposures varied significantly; Cluster five showed the highest CO2 emissions and solar irradiance, while Cluster three had the lowest environmental burden. PCA showed that clinical manifestations, disease activity and chronicity were different across clusters. The figure highlights the separation of the characteristics according to the three principal components.Abstract PO:07:188 Figure 1Three-dimensional representation of the first three principal components, showing the five clusters of SLE patients derived from socioeconomie and environmental variablesConclusions Socioeconomic and environmental factors at the individual, regional, and national levels influence the cumulative clinical manifestations and patient-reported outcomes in SLE. Our findings underscore the role of social vulnerability and environmental stressors as potential modifiers of SLE phenotype in Latin America, highlighting the need for context-sensitive interventions and policies to mitigate health inequities.