Poverty, Neighborhoods, Persistent Stress, and SLE Outcomes:A Qualitative Study of the Patients' Perspective.

OBJECTIVE: To obtain the perspective of individuals with SLE about the role of poverty, neighborhood, and chronic stress in SLE outcomes.

METHODS: 723 persons with SLE were followed from 2003-2015 through annual structured interviews as part of the Lupus Outcomes Study to establish the effect of combinations of poverty, persistent poverty, living in an area of concentrated poverty, access to health care, and chronic stress on accumulated damage. We sampled 28 from the 723 on the basis of household income, geography, and outcomes in their last interview, and administered qualitative interviews to explore their perspectives on these factors on outcomes. The interviews were recorded and transcribed and analyzed using a grounded-theory approach.

RESULTS: Persons in poverty frequently reported that poverty necessitated a choice to deal with food, medical care, and housing insecurity on a daily basis and to relegate dealing with SLE to a time of disease flares. They also reported that exposure to crime in their neighborhoods was a stress that triggered worsened disease activity. Affluent participants reported that neighborhood neither helped nor hindered dealing with SLE since they relied on networks not tied to neighborhoods to deal with SLE.

CONCLUSION: Mitigating poverty and reducing exposure to crime through moving to safer neighborhoods are factors identified by patients as potentially critical in outcomes for SLE This article is protected by copyright. All rights reserved.