Ethnic disparities among patients with pulmonary hypertension associated with systemic sclerosis.

OBJECTIVE: To examine a cohort of patients with systemic sclerosis (SSc) and pulmonary hypertension (PH) for ethnic disparities in clinical presentation, disease detection, or management. METHODS: Encounters of patients with SSc seen at the Medical University of South Carolina were recorded in a computerized database from November 1997 through January 2004. Patients were evaluated for discrepancy in disease manifestation and treatment. Evaluation criteria included patient ethnicity (by self report), age, disease duration from onset of first non-Raynaud's symptom, presence or absence of PH, incidence of diastolic dysfunction and left ventricular hypertrophy among patients with PH, severity of interstitial lung disease, and treatment course. RESULTS: African Americans were more likely than Caucasians to have diffuse cutaneous SSc (dcSSc) (69.9% vs 42.9%, p < 0.001) and they presented with PH (defined as right ventricular systolic pressure > 40 mm Hg by echocardiogram or mean pulmonary artery pressure > 25 mm Hg by right heart catheterization (RHC) at a younger age (60.9 yrs vs 49.0 yrs, p < 0.001). There were no ethnic disparities in time from onset of the first non-Raynaud's symptom to detection of PH, method of PH detection, or treatment modalities. Patients with PH were more likely to have diastolic dysfunction than those without PH (52.3% vs 35.9%, p = 0.011). CONCLUSION: In this cohort of patients, African Americans were more likely to have dcSSc. Among patients with PH, African Americans presented at a younger age than their Caucasian counterparts. Incidence of diastolic dysfunction was higher in the PH population. There were no significant ethnic disparities in time of progression to PH or in treatment modalities employed in our cohort.

Racial variation in clinical and immunological manifestations of systemic sclerosis.

OBJECTIVE: To clarify which racial differences in disease manifestations can be attributed to differences in other factors such as gender, education, disease classification, and disease duration. METHODS: The study included white and black patients with systemic sclerosis (SSc) treated at a university hospital rheumatology clinic between November 1997 and April 2003. Demographic, clinical, and immunological measurements were obtained on each subject. Using multivariable statistical techniques we assessed differences in disease manifestations between white and black patients after adjusting for gender and classification and duration of disease. RESULTS: Two hundred sixty-three patients (199 whites, 64 blacks) were enrolled in the study. Blacks experienced an earlier age at disease onset than whites and were significantly more likely to have diffuse disease, digital ulcers, digital pitting, impaired lung function, and anti-RNP, and anti-Ro antibodies. Whites were significantly more likely to have anti-centromere antibodies. CONCLUSION: After adjusting for gender, disease classification, and disease duration, whites and blacks with SSc differ in some clinical and immunological manifestations of disease. Whether these differences can be attributed to genetic or environmental factors remains unknown.

Demographic and clinical factors associated with in-hospital death among patients with systemic sclerosis.

OBJECTIVE: To examine demographic and clinical predictors of in-hospital death of patients with systemic sclerosis (SSc) and determine to what extent apparent racial differences may be attributed to socioeconomic factors. METHODS: Data were obtained on all hospitalizations in South Carolina for patients who were ever hospitalized between 1996 and 2000 with a diagnosis of SSc. Multiple logistic regression was used to examine predictors of in-hospital death among whites, blacks, and other patients. RESULTS: Proportions of in-hospital deaths among blacks (23.0%) and others (27.7%) were higher than among whites (15.6%), a finding that remained after adjustment for other sociodemographic and clinical factors (black/white odds ratio: 1.70, 95% confidence interval: 1.01-2.86; other/white OR 2.06, 95% CI 1.04-4.09). Other factors associated with in-hospital death included transfer status, emergency admission, length of stay, number of hospitalizations during the time period, and presence of congestive heart failure (OR 1.79; 95% CI 1.06-3.03) or hypertension (OR 0.41; 95% CI 0.23-0.71). CONCLUSION: Black and other non-white patients with SSc appear to experience an elevated risk of death during their hospital stays. Further research is necessary to understand the reasons for these disparities.

Correlates of depression, including overall and gastrointestinal functional status, among patients with systemic sclerosis.

OBJECTIVE: Patients with systemic sclerosis (SSc) may develop psychological problems in addition to physiologic symptoms. We investigated whether demographic and clinical factors are associated with comorbid depression. METHODS: From a university hospital's rheumatology clinic, 72 SSc patients who completed 3 questionnaires [Center for Epidemiologic Studies Depression (CES-D) scale, an abbreviated version of a functional status instrument, the Scleroderma Health Assessment Questionnaire (SHAQ), and the Gastrointestinal Quality of Life Index (GIQLI)] during an examination were recruited into the study. Correlations among scores on the 3 questionnaires [including upper and lower gastrointestinal (GI) tract subscales of the GIQLI] were calculated, and associations between CES-D scores and a variety of demographic and clinical characteristics were examined using stepwise linear regression. RESULTS: Higher CES-D scores (i.e., more depression symptoms) were significantly correlated with upper (r = -0.48, p < 0.0001) and lower (r = -0.41, p < 0.001) GI tract dysfunction and worse overall functional status (r = 0.51, p < 0.0001). Stepwise regression indicated that higher levels of depression were independently associated with lower levels of education (p < 0.01), worse upper GI tract functioning (p = 0.019), worse functional status (p = 0.34), current corticosteroid use (p = 0.061), and cardiac involvement (p = 0.086). CONCLUSION: Decreased functional status and abnormal GI functioning are significantly correlated with depression among patients with SSc. Other demographic and clinical indicators are also associated with depression.