Liz Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the Faculty of Medicine, Imperial College London, discussed the influence of genetics and background on the care management of lupus nephritis.
An increased risk for worse patient outcomes in lupus nephritis have been associated with non–Northern European White individuals and those from low socioeconomic backgrounds, said Liz Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the Faculty of Medicine, Imperial College London.
How do race and sociodemographic factors impact patient outcomes and care management in lupus nephritis?
So, we know that being from a deprived background is likely to lead to a worse outcome. And that's really complex—it’s education level, it’s access to treatment, it’s speed with which you get your treatment. If you're in a job that you're only paid when you're there, and you need to go to clinic—it's a choice between do you earn or do you get your health care done. So, all those factors, I think, feed in hugely.
Everyone who is non–Northern European White has a risk of worse outcomes with lupus. I'm not quite sure why that is and what the genetic impacts are. In the Black population, it's related to the APOL1 gene, almost certainly giving them an extra bonus hit of doing badly if you've already got kidney disease, that's work known from a long time ago.
There's also issues about trust, involvement, and understanding of the need to be in trials. And I think we need to do a huge piece of work. I know particularly in the United States, there's enormous distrust in the African American community around trials. And I think it's our duty and our job to find ways of showing that we can be trusted and that it is hugely valuable to their communities for people to go in. And it just takes time. It takes time and effort to involve people. I treat, in West London, a very, very diverse community, and I have to say nearly everyone I've gotten into trials has been non-White, but it takes a lot of time and effort.