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Understanding the overall burden and contribution of each domain could guide future health equity\u2013focused interventions to improve outcomes and reduce disparities in LN. Objectives of this meta\u2010analysis were to 1) determine the association of overall SDoH and specific SDoH domains on LN outcomes and 2) develop a framework for the multidimensional impact of SDoH on LN outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a comprehensive search of studies measuring associations between SDoH and LN outcomes. We examined pooled odds of poor LN outcomes including death, end\u2010stage kidney disease, or cardiovascular disease in patients with and without adverse SDoH. Additionally, we calculated the pooled odds ratios of outcomes by four SDoH domains: individual (eg, insurance), health care (eg, fragmented care), community (eg, neighborhood socioeconomic status), and health behaviors (eg, smoking).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 531 screened studies, 31 meeting inclusion criteria and 13 with raw data were included in meta\u2010analysis. Pooled odds of poor outcomes were 1.47\u2010fold higher in patients with any adverse SDoH. Patients with adverse SDoH in individual and health care domains had 1.64\u2010fold and 1.77\u2010fold higher odds of poor outcomes. We found a multiplicative impact of having two or more adverse SDoH on LN outcomes. Black patients with public insurance and fragmented care had 12\u2010fold higher odds of poor LN outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adverse SDoH is associated with poor LN outcomes. Having two or more adverse SDoH, specifically in different SDoH domains, had a multiplicative impact leading to worse LN outcomes, widening disparities.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/acr25359-toc-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.25359","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:20:03Z","timestamp":1714609203000},"page":"1232-1245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Multiplicative Impact of Adverse Social Determinants of Health on Outcomes in Lupus Nephritis: A Meta\u2010analysis and Systematic Review"],"prefix":"10.1002","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7272-2692","authenticated-orcid":false,"given":"Shivani","family":"Garg","sequence":"first","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health  Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Sweet","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health  Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brianna","family":"Boderman","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health  Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Montes","sequence":"additional","affiliation":[{"name":"Mayo Clinic  Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7653-3650","authenticated-orcid":false,"given":"Theresa","family":"Walunas","sequence":"additional","affiliation":[{"name":"Northwestern University  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8712-787X","authenticated-orcid":false,"given":"Rosalind","family":"Ramsey\u2010Goldman","sequence":"additional","affiliation":[{"name":"Northwestern University  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8365-8497","authenticated-orcid":false,"given":"Arezou","family":"Khosroshahi","sequence":"additional","affiliation":[{"name":"Emory University  Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad C.","family":"Astor","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health  Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2361-0787","authenticated-orcid":false,"given":"S. Sam","family":"Lim","sequence":"additional","affiliation":[{"name":"Emory University  Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6523-0374","authenticated-orcid":false,"given":"Christie M.","family":"Bartels","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health  Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,23]]},"reference":[{"issue":"9","key":"e_1_2_7_2_1","first-page":"1770","article-title":"Hospitalization and mortality of patients with systemic lupus erythematosus","volume":"33","author":"Krishnan E.","year":"2006","journal-title":"J Rheumatol"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1191\/0961203302lu158oa"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000224709.70133.f7"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1191\/9612332lu155oa"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(00)70316-7"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203316631629"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2020.07.002"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6818a4"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38239"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000840"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.40512"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2014.04.001"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2022-000698"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.22.2879"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0033-3549(04)50073-0"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocaa143"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000646"},{"key":"e_1_2_7_19_1","unstructured":"SolarO IrwinA.A conceptual framework for action on the social determinants of health. 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