{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T05:06:51Z","timestamp":1776402411885,"version":"3.51.2"},"reference-count":43,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T00:00:00Z","timestamp":1732060800000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Excellent postdoctoral innovative talents of Hunan province","award":["2020RC2014"],"award-info":[{"award-number":["2020RC2014"]}]},{"name":"15th medium-term special grant of postdoctoral Science Foundation of China","award":["2022T150742"],"award-info":[{"award-number":["2022T150742"]}]},{"DOI":"10.13039\/501100005150","name":"Chinese Academy of Medical Sciences","doi-asserted-by":"publisher","award":["2020-RC320-003"],"award-info":[{"award-number":["2020-RC320-003"]}],"id":[{"id":"10.13039\/501100005150","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81874253"],"award-info":[{"award-number":["81874253"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Special Program of National Natural Science Foundation of China","award":["32141004"],"award-info":[{"award-number":["32141004"]}]},{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2021JJ40837"],"award-info":[{"award-number":["2021JJ40837"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019018","name":"Chinese Academy of Medical Sciences Initiative for Innovative Medicine","doi-asserted-by":"publisher","award":["2020RC2014"],"award-info":[{"award-number":["2020RC2014"]}],"id":[{"id":"10.13039\/501100019018","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Key R&D Program of China","award":["2022YFC3601800"],"award-info":[{"award-number":["2022YFC3601800"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2024,10,27]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Systemic lupus erythematosus (SLE) is an autoimmune disease characterised by a loss of immune tolerance, affecting multiple organs and significantly impairing patients\u2019 health and quality of life. While hereditary elements are essential in the onset of SLE, external environmental influences are also significant. Currently, there are few predictive models for SLE that takes into account the impact of occupational and living environmental exposures. Therefore, we collected basic information, occupational background and living environmental exposure data from patients with SLE to construct a predictive model that facilitates easier intervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a study comparing 316 individuals diagnosed with SLE and 851 healthy volunteers in a case\u2013control design, collecting their basic information, occupational exposure history and environmental exposure data. Subjects were randomly allocated into training and validation groups using a 70\/30 split. Using three-feature selection methods, we constructed four predictive models with multivariate logistic regression. Model performance and clinical utility were evaluated via receiver operating characteristic, calibration and decision curves. Leave-one-out cross-validation further validated the models. The best model was used to create a dynamic nomogram, visually representing the predicted relative risk of SLE onset.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The ForestMDG model demonstrated strong predictive ability, with an area under the curve of 0.903 (95% CI 0.880 to 0.925) in the training set and 0.851 (95% CI 0.809 to 0.894) in the validation set, as indicated by model performance evaluation. Calibration and decision curves demonstrated accurate results along with practical clinical value. Leave-one-out cross-validation confirmed that the ForestMDG model had the best accuracy (0.8338). Finally, we developed a dynamic nomogram for practical use, which is accessible via the following link: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/yingzhang99321.shinyapps.io\/dynnomapp\/\">https:\/\/yingzhang99321.shinyapps.io\/dynnomapp\/<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We created a user-friendly dynamic nomogram for predicting the relative risk of SLE onset based on occupational and living environmental exposures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>ChiCTR2000038187.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/lupus-2024-001311","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T01:25:34Z","timestamp":1732152334000},"page":"e001311","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Development of a predictive model for systemic lupus erythematosus incidence risk based on environmental exposure factors"],"prefix":"10.1136","volume":"11","author":[{"given":"Ying","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing, China"},{"name":"Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China"},{"name":"Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China"},{"name":"Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng","family":"Zhao","sequence":"additional","affiliation":[{"name":"Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China"},{"name":"Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China"},{"name":"Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China"},{"name":"Hunan Key Laboratory of Medical Epigenomics, Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Lei","sequence":"additional","affiliation":[{"name":"Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China"},{"name":"Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China"},{"name":"Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China"},{"name":"Hunan Key Laboratory of Medical Epigenomics, Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qilin","family":"Li","sequence":"additional","affiliation":[{"name":"Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China"},{"name":"Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China"},{"name":"Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China"},{"name":"Hunan Key Laboratory of Medical Epigenomics, Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Jin","sequence":"additional","affiliation":[{"name":"Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China"},{"name":"Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China"},{"name":"Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China"},{"name":"Hunan Key Laboratory of Medical Epigenomics, Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4192-4897","authenticated-orcid":false,"given":"Qianjin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing, China"},{"name":"Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China"},{"name":"Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China"},{"name":"Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China"},{"name":"Hunan Key Laboratory of Medical Epigenomics, Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,11,20]]},"reference":[{"key":"2025091513523632000_11.2.e001311.1","doi-asserted-by":"crossref","first-page":"ITC81","DOI":"10.7326\/AITC202006020","article-title":"Systemic Lupus Erythematosus","volume":"172","author":"Kiriakidou","year":"2020","journal-title":"Ann Intern Med"},{"key":"2025091513523632000_11.2.e001311.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30237-5"},{"key":"2025091513523632000_11.2.e001311.3","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.autrev.2017.01.007","article-title":"Gender balance in patients with systemic lupus erythematosus","volume":"16","author":"Margery-Muir","year":"2017","journal-title":"Autoimmun Rev"},{"key":"2025091513523632000_11.2.e001311.4","doi-asserted-by":"crossref","DOI":"10.1007\/s11926-020-00937-0","article-title":"Lupus Vasculitis","volume":"22","author":"Calle-Botero","year":"2020","journal-title":"Curr Rheumatol Rep"},{"key":"2025091513523632000_11.2.e001311.5","doi-asserted-by":"crossref","first-page":"93","DOI":"10.55563\/clinexprheumatol\/jrz47c","article-title":"Rare clinical manifestations in systemic lupus erythematosus: a review on frequency and clinical presentation","volume":"40 Suppl 134","author":"Tani","year":"2022","journal-title":"Clin Exp Rheumatol"},{"key":"2025091513523632000_11.2.e001311.6","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223035"},{"key":"2025091513523632000_11.2.e001311.7","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-021-00668-1"},{"key":"2025091513523632000_11.2.e001311.8","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2016.137"},{"key":"2025091513523632000_11.2.e001311.9","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2009.106"},{"key":"2025091513523632000_11.2.e001311.10","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2015.33"},{"key":"2025091513523632000_11.2.e001311.11","doi-asserted-by":"crossref","first-page":"109122","DOI":"10.1016\/j.biopha.2019.109122","article-title":"Current mechanistic insights into the role of infection in systemic lupus erythematosus","volume":"117","author":"Pan","year":"2019","journal-title":"Biomed Pharmacother"},{"key":"2025091513523632000_11.2.e001311.12","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1002\/art.41935","article-title":"Association of a Combination of Healthy Lifestyle Behaviors With Reduced Risk of Incident Systemic Lupus Erythematosus","volume":"74","author":"Choi","year":"2022","journal-title":"Arthritis Rheumatol"},{"key":"2025091513523632000_11.2.e001311.13","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.autrev.2018.11.005","article-title":"The study of interactions between genome and exposome in the development of systemic lupus erythematosus","volume":"18","author":"Leffers","year":"2019","journal-title":"Autoimmun Rev"},{"key":"2025091513523632000_11.2.e001311.14","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-022-00727-y"},{"key":"2025091513523632000_11.2.e001311.15","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1093\/ije\/dyaa287","article-title":"Occupational exposure to respirable crystalline silica and risk of autoimmune rheumatic diseases: a nationwide cohort study","volume":"50","author":"Boudigaard","year":"2021","journal-title":"Int J Epidemiol"},{"key":"2025091513523632000_11.2.e001311.16","doi-asserted-by":"crossref","first-page":"112862","DOI":"10.1016\/j.envres.2022.112862","article-title":"Pesticide use and risk of systemic autoimmune diseases in the Agricultural Health Study","volume":"209","author":"Parks","year":"2022","journal-title":"Environ Res"},{"key":"2025091513523632000_11.2.e001311.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12940-023-01019-1","article-title":"Association of Perfluoroalkyl and polyfluoroalkyl substances (PFASs) exposures and the risk of systemic lupus erythematosus: a case-control study in China","volume":"22","author":"He","year":"2023","journal-title":"Environ Health"},{"key":"2025091513523632000_11.2.e001311.18","doi-asserted-by":"crossref","unstructured":"Wang H , Banerjee N , Wang G , et al . Autophagy dysregulation in trichloroethene-mediated inflammation and autoimmune response. Toxicology 2023;487. doi:10.1016\/j.tox.2023.153468","DOI":"10.1016\/j.tox.2023.153468"},{"key":"2025091513523632000_11.2.e001311.19","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13448"},{"key":"2025091513523632000_11.2.e001311.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2019.03.018"},{"key":"2025091513523632000_11.2.e001311.21","doi-asserted-by":"crossref","first-page":"171841","DOI":"10.1016\/j.scitotenv.2024.171841","article-title":"Environmental exposure to polycyclic aromatic hydrocarbons: An underestimated risk factor for systemic lupus erythematosus onset and progression","volume":"926","author":"Jin","year":"2024","journal-title":"Sci Total Environ"},{"key":"2025091513523632000_11.2.e001311.22","doi-asserted-by":"crossref","first-page":"152143","DOI":"10.1016\/j.semarthrit.2022.152143","article-title":"Risk prediction models for incident systemic lupus erythematosus among women in the Nurses\u2019 health study cohorts using genetics, family history, and lifestyle and environmental factors","volume":"58","author":"Cui","year":"2023","journal-title":"Semin Arthritis Rheum"},{"key":"2025091513523632000_11.2.e001311.23","doi-asserted-by":"crossref","DOI":"10.3389\/fgene.2022.902793","article-title":"Random forests algorithm boosts genetic risk prediction of systemic lupus erythematosus","volume":"13","author":"Ma","year":"2022","journal-title":"Front Genet"},{"key":"2025091513523632000_11.2.e001311.24","doi-asserted-by":"publisher","DOI":"10.1080\/1744666X.2017.1327352"},{"key":"2025091513523632000_11.2.e001311.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2019.09.012"},{"key":"2025091513523632000_11.2.e001311.26","doi-asserted-by":"crossref","first-page":"115","DOI":"10.2478\/rir-2023-0019","article-title":"2022 Chinese guideline for the management of pregnancy and reproduction in systemic lupus erythematosus","volume":"4","author":"Tian","year":"2023","journal-title":"Rheumatol Immunol Res"},{"key":"2025091513523632000_11.2.e001311.27","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-022-14840-4","article-title":"Clinical and laboratorial outcome of different age-onset systemic lupus erythematosus patients in Jiangsu, China: a multicentre retrospective study","volume":"12","author":"Wen","year":"2022","journal-title":"Sci Rep"},{"key":"2025091513523632000_11.2.e001311.28","first-page":"527","article-title":"Pesticides, chemical and industrial exposures in relation to systemic lupus erythematosus","volume":"23","author":"Parks","year":"2014","journal-title":"Lupus (Los Angel)"},{"key":"2025091513523632000_11.2.e001311.29","first-page":"2129","article-title":"Pesticide exposure and risk of systemic lupus erythematosus in an urban population of predominantly African-American women","volume":"27","author":"Williams","year":"2018","journal-title":"Lupus (Los Angel)"},{"key":"2025091513523632000_11.2.e001311.30","doi-asserted-by":"publisher","DOI":"10.3109\/1547691X.2011.642103"},{"key":"2025091513523632000_11.2.e001311.31","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.tox.2016.08.003","article-title":"Different end-points to assess effects in systemic lupus erythematosus patients exposed to pesticide mixtures","volume":"376","author":"Simoniello","year":"2017","journal-title":"Toxicology"},{"key":"2025091513523632000_11.2.e001311.32","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1703167114"},{"key":"2025091513523632000_11.2.e001311.33","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1111\/ina.12631","article-title":"Indoor thermal environment and air quality in Chinese-style residential kitchens","volume":"30","author":"Liu","year":"2020","journal-title":"Indoor Air"},{"key":"2025091513523632000_11.2.e001311.34","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.scitotenv.2019.02.316","article-title":"Characteristics of cooking-generated PM10 and PM2.5 in residential buildings with different cooking and ventilation types","volume":"668","author":"Kang","year":"2019","journal-title":"Sci Total Environ"},{"key":"2025091513523632000_11.2.e001311.35","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.envpol.2018.02.054","article-title":"Household air pollution and personal exposure to air pollutants in rural China \u2013 A review","volume":"237","author":"Du","year":"2018","journal-title":"Environ Pollut"},{"key":"2025091513523632000_11.2.e001311.36","doi-asserted-by":"crossref","first-page":"110028","DOI":"10.1016\/j.envres.2020.110028","article-title":"Household air pollution exposure and associations with household characteristics among biomass cookstove users in Puno, Peru","volume":"191","author":"Fandi\u00f1o-Del-Rio","year":"2020","journal-title":"Environ Res"},{"key":"2025091513523632000_11.2.e001311.37","doi-asserted-by":"publisher","DOI":"10.1007\/s00403-008-0897-3"},{"key":"2025091513523632000_11.2.e001311.38","doi-asserted-by":"crossref","first-page":"116222","DOI":"10.1016\/j.envres.2023.116222","article-title":"Endocrine-disrupting chemicals and autoimmune diseases","volume":"231","author":"Huang","year":"2023","journal-title":"Environ Res"},{"key":"2025091513523632000_11.2.e001311.39","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.envres.2015.12.021","article-title":"Fine particulate air pollution and systemic autoimmune rheumatic disease in two Canadian provinces","volume":"146","author":"Bernatsky","year":"2016","journal-title":"Environ Res"},{"key":"2025091513523632000_11.2.e001311.40","doi-asserted-by":"crossref","DOI":"10.1186\/s12989-021-00407-0","article-title":"Chronic exposure to PM2.5 aggravates SLE manifestations in lupus-prone mice","volume":"18","author":"Yariwake","year":"2021","journal-title":"Part Fibre Toxicol"},{"key":"2025091513523632000_11.2.e001311.41","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17238972","article-title":"Indoor Exposure to Selected Air Pollutants in the Home Environment: A Systematic Review","volume":"17","author":"Vardoulakis","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025091513523632000_11.2.e001311.42","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.envres.2017.01.001","article-title":"Measurements of intermediate-frequency electric and magnetic fields in households","volume":"154","author":"Aerts","year":"2017","journal-title":"Environ Res"},{"key":"2025091513523632000_11.2.e001311.43","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2022.928379","article-title":"Volatile organic compounds: A proinflammatory activator in autoimmune diseases","volume":"13","author":"Ogbodo","year":"2022","journal-title":"Front Immunol"}],"container-title":["Lupus Science &amp; Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/lupus-2024-001311","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T20:52:48Z","timestamp":1757969568000},"score":1,"resource":{"primary":{"URL":"https:\/\/lupus.bmj.com\/lookup\/doi\/10.1136\/lupus-2024-001311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":43,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,11,20]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/lupus-2024-001311"],"URL":"https:\/\/doi.org\/10.1136\/lupus-2024-001311","relation":{},"ISSN":["2053-8790"],"issn-type":[{"value":"2053-8790","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}