{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:06:04Z","timestamp":1793412364439,"version":"4.5.0"},"reference-count":13,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:sec id=\"ab-dbr240013-4\"><jats:title>Importance<\/jats:title><jats:p>The association of area deprivation with outcomes in discoid lupus erythematosus (DLE) remains poorly understood.<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr240013-5\"><jats:title>Objective<\/jats:title><jats:p>To determine the association between US Census block measures of deprivation and disease severity in adult patients with DLE.<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr240013-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional study included 154 patients with DLE seen between January 1, 2007, and January 1, 2024, at a single-center referral-based specialty rheumatologic-dermatology clinic in Philadelphia, Pennsylvania. Patients were aged 18 to 73 years and were enrolled in the University of Pennsylvania\u2019s Cutaneous Lupus Erythematosus Database study. Data were analyzed between January 1, 2024, and May 8, 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr240013-7\"><jats:title>Exposures<\/jats:title><jats:p>Residence in a highly disadvantaged area as geocoded by a state area deprivation index (ADI).<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr240013-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The main outcome was DLE disease severity as codified by the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) damage and activity scores.<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr240013-9\"><jats:title>Results<\/jats:title><jats:p>A total of 154 adult patients with DLE (128 women [83%] and 26 men [17%]; mean [SD] age, 43 [13] years; 6 [4%] Asian individuals, 98 [64%] Black individuals, 2 [1%] Hispanic individuals, 46 [30%] White individuals, and 2 individuals [1%] with other race or ethnicity; 78 [51%] with an ADI &amp;amp;gt;5; 43 who currently smoked [28%];and 56 [36%] with concurrent systemic lupus erythematosus) were included in the analysis. By multivariable logistic regression, residence within communities with an ADI greater than 5 was associated with nearly 4-fold greater odds of moderate to severe damage (odds ratio [OR], 3.90; 95% CI, 1.27-12.69] and activity (OR, 3.31; 95% CI, 1.27-9.44). Concurrent cigarette smoking was similarly associated with greater odds of moderate to severe damage (OR, 3.15; 95% CI, 1.09-10.29). After controlling for ADI and other confounders, race was not significantly associated with DLE disease severity.<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr240013-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The results of this cross-sectional study suggest that geospatial disadvantage is associated with DLE disease severity independent of race. This invites a paradigm shift that considers the social context within which racial disparities are observed, highlighting the potential for geographically targeted interventions and policy changes to improve patient outcomes in DLE.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2024.2355","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T15:39:06Z","timestamp":1721835546000},"page":"984","source":"Crossref","is-referenced-by-count":16,"title":["Area Deprivation and Disease Severity in Adult Patients With Discoid Lupus Erythematosus"],"prefix":"10.1001","volume":"160","author":[{"given":"Daniella Forman","family":"Faden","sequence":"first","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania"},{"name":"Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Xie","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania"},{"name":"Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Stone","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania"},{"name":"Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lais","family":"Lopes Almeida Gomes","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania"},{"name":"Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd","family":"Le","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nnenna","family":"Ezeh","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Buckingham","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Kind","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth Ann","family":"Vleugels","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria P.","family":"Werth","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania"},{"name":"Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Arkin","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina S.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"5","key":"dbr240013r1","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.autrev.2005.01.003","article-title":"Clinical manifestations of cutaneous lupus erythematosus.","volume":"4","author":"Werth","year":"2005","journal-title":"Autoimmun 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