{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:31:40Z","timestamp":1786509100500,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["5P30-AR072582"],"award-info":[{"award-number":["5P30-AR072582"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Childhood-onset systemic lupus erythematosus (cSLE) is a chronic, multisystem autoimmune disease that is associated with more severe organ involvement, more intensive drug therapy, and increased long-term organ damage compared with adult-onset disease. The objectives of this study were to evaluate the performance of widely used small area-level multidimensional indicators of neighborhood disadvantage in a mixed urban\u2013rural cSLE cohort against disease outcomes. Methods: This retrospective cohort study utilized electronic health records to identify and evaluate pediatric patients with cSLE across a single center in South Carolina between 1 January 2020 and 31 December 2024. Primary outcomes included disease activity at diagnosis, measured by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K); the achievement of a low lupus disease activity state (LLDAS) by the last visit; the development of major organ involvement; and the rates of unplanned hospitalizations and emergency department visits. The associations of the census tract-level Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Childhood Opportunity Index (COI) with clinical presentation and outcomes were estimated using generalized linear models and logistic regression. Results: A total of 85 patients with cSLE were included, of which 76% reported being of Black race, and 28% lived in rural areas. Lupus disease severity was inconsistent across the metrics of area-level social vulnerability, neighborhood deprivation, child opportunity, and rurality. Patients who lived in more socially vulnerable communities were more likely to attain LLDAS during follow-up, while those who lived in lower-opportunity areas were more likely to develop CNS lupus. Baseline disease activity, renal involvement, and healthcare use were not significantly associated with area-level social disadvantages or rurality. Conclusions: In this single-center, mixed urban\u2013rural cohort of children with cSLE, indicators of neighborhood-level disadvantage and rurality alone explained little variation in disease severity and disease control overall. The utility of available small area-level metrics is likely context-dependent and influenced by regional features, population characteristics, and the outcomes being studied. Future work should integrate individual- and area-level factors across diverse settings to better understand the drivers of health disparities.<\/jats:p>","DOI":"10.3390\/children13081062","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:08:53Z","timestamp":1786349333000},"page":"1062","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the Relationship Between Multidimensional Area-Level Indicators and Lupus Disease Activity in Children"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4645-2187","authenticated-orcid":false,"given":"Chelsea","family":"Reynolds","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3933-4986","authenticated-orcid":false,"given":"Paul J.","family":"Nietert","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mileka","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Vara","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9416-0755","authenticated-orcid":false,"given":"Natasha","family":"Ruth","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1691-4814","authenticated-orcid":false,"given":"Joyce","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Boston Children\u2019s Hospital, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2546800","DOI":"10.1001\/jamanetworkopen.2025.46800","article-title":"Estimation of Mortality via the Neighborhood Atlas and Reproducible Area Deprivation Indices","volume":"9","author":"Gladish","year":"2026","journal-title":"JAMA Netw. 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