Addressing Economic Insecurities Can Improve Patient-Reported Outcomes in Lupus.

Abstract

Economic insecurities, such as food, housing, transportation, and financial challenges, are modifiable risk factors and influence patient-reported outcomes (PROs) in systemic lupus erythematosus (SLE). We examined the following: (1) associations between economic insecurities and PROs, and (2) the impact of screening and addressing economic insecurities during SLE visits. In the Collaborative Lupus Clinics at the University of Wisconsin-Madison, patients were routinely screened for economic insecurities and met with a social worker (SW) during visits. Clinical data including PROs from the Patient-Reported Outcomes Measurement Information System Global Health Short Form at baseline and follow-up were abstracted from the Collaborative Lupus Clinics Data Repository. Using multivariable linear regression, associations among economic insecurities, social drivers of health (eg, insurance), and PROs were assessed. Next, changes in PROs following SW discussions were evaluated. Among 222 patients (mean age 47 years; 90% women), 16% reported at least one economic insecurity. Each 1-point increase in economic insecurity score was linked with lower PRO T scores in all domains: physical health (-1.85, P = 0.04), mental health (-1.32, P = 0.17), and social function (-0.24, P = 0.03). A sequential increase in economic insecurities, at least one, at least two, and at least three, lowered physical health by 2.00, 3.86, and 9.10 points, respectively. Patients with economic insecurities and Medicaid/no insurance had two times lower PRO scores in all domains. Following SW intervention, PROs improved by 4.52, 1.12, and 0.69 points in all domains. Although economic insecurities negatively affect PROs in SLE, a systematic approach to assess and address economic insecurities in clinics can improve PROs over time in SLE.