{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:07:23Z","timestamp":1790316443004,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,8,7]],"date-time":"2019-08-07T00:00:00Z","timestamp":1565136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>African Americans with scleroderma have more severe disease and higher mortality than non\u2013African Americans. Differences in rates of diffuse disease, autoantibody status, or socioeconomic status have not completely explained this phenomenon. Our study evaluates these risks at our site.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study comparing African American and non\u2013African American patients with scleroderma seen from 2008 to 2016 was performed. Groups were matched by sex, age at first visit, date of first visit, disease duration at first visit, and limited versus diffuse cutaneous disease. Demographic, serologic, and clinical features were compared. Mortality risks were assessed by a Cox proportional hazards model with covariates of race, marital status, education, employment, insurance, and imputed household income.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>African Americans comprised 202 of 402 patients. They demonstrated reduced forced vital capacity and diffusing capacity for carbon monoxide, more severe lung fibrosis, a higher prevalence of pulmonary hypertension, and more severe cardiac involvement. The autoantibody profile statistically differed between the 2 groups. Death during follow\u2010up was 21% in African Americans versus 11% in non\u2013African Americans (<jats:italic>P<\/jats:italic> = 0.005). African American race demonstrated an unadjusted hazard ratio for death during follow\u2010up of 2.061 (<jats:italic>P<\/jats:italic> = 0.006) that declined with adjustment for socioeconomic covariates to 1.256 (<jats:italic>P<\/jats:italic> = 0.633). The only significant covariate was median income in tens of thousands of dollars by zip code (hazard ratio 0.845; <jats:italic>P<\/jats:italic> = 0.033).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>African American patients with scleroderma have more severe pulmonary disease and higher unadjusted mortality than matched non\u2013African Americans. Following adjustment for socioeconomic factors, African American race was not a significant risk factor for mortality; however, independent of race, a lower median household income predicted increased mortality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23861","type":"journal-article","created":{"date-parts":[[2019,3,1]],"date-time":"2019-03-01T09:45:34Z","timestamp":1551433534000},"page":"1154-1163","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Increased Morbidity and Mortality of Scleroderma in African Americans Compared to Non\u2013African Americans"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9469-0919","authenticated-orcid":false,"given":"Duncan F.","family":"Moore","sequence":"first","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Kramer","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Eltaraboulsi","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia D.","family":"Steen","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400421"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.11073"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400309"},{"key":"e_1_2_6_5_1","first-page":"263","article-title":"Racial variation in clinical and immunological manifestations of systemic sclerosis","volume":"33","author":"Nietert PJ","year":"2006","journal-title":"J Rheumatol"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34482"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e31829be125"},{"key":"e_1_2_6_8_1","first-page":"1277","article-title":"Ethnic disparities among patients with pulmonary hypertension associated with systemic sclerosis","volume":"34","author":"Beall AD","year":"2007","journal-title":"J Rheumatol"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.114.3.801"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780370903"},{"key":"e_1_2_6_11_1","first-page":"2031","article-title":"Hospital admissions, length of stay, charges, and in\u2010hospital death among patients with systemic sclerosis","volume":"28","author":"Nietert PJ","year":"2001","journal-title":"J Rheumatol"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199904)42:3<465::AID-ANR11>3.0.CO;2-Y"},{"key":"e_1_2_6_13_1","first-page":"1888","article-title":"Demographic and clinical factors associated with in\u2010hospital death among patients with systemic sclerosis","volume":"32","author":"Nietert PJ","year":"2005","journal-title":"J Rheumatol"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0b013e318124a89e"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199710000-00002"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/sarh.2001.20268"},{"key":"e_1_2_6_17_1","first-page":"1238","article-title":"Patterns of hospital admissions and emergency room visits among patients with scleroderma in South Carolina, USA","volume":"30","author":"Nietert PJ","year":"2003","journal-title":"J Rheumatol"},{"key":"e_1_2_6_18_1","unstructured":"Population Studies Center Institute for Social Research University of Michigan.Zip code characteristics: mean and median household income. 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