Q&A: How do health disparities and social determinants of health affect Hispanic/Latino communities?
We asked Dr. Cristina Drenkard to participate in a Q&A blog about health disparities and social determinants of health. Dr. Drenkard discusses what these terms mean and how it can affect people who have lupus in the Hispanic/Latino community.
What are health disparities? What are some of the factors that contribute to health disparities for lupus patients?
Health disparities are differences in one or more aspects of health that occur between defined populations or population groups. Although in the United States (U.S.), the definition of disparities encompasses differences in health indicators, regardless of their roots or causes, the concept is used more specifically to refer to potentially avoidable and unjust differences. Therefore, disparities can also be explained as inequalities that affect disadvantaged population groups, in relation to race and ethnicity, sex, sexual orientation, age, disability, socioeconomic level and geographic location. For example, in the U.S., the rate of illness, injury, death and disability is disproportionately higher in the Hispanic population than in the non-Hispanic white population, which represents the largest racial and ethnic population in the U.S.
Lupus is a disease characterized by marked health disparities. Not only is systemic lupus erythematosus (SLE) about 10 times more common in women than men, but this disease disproportionately affects young women and people of color. In addition, these minority groups tend to have more severe forms of SLE, with higher mortality and worse outcomes. For example, in the U.S., SLE is the fifth leading cause of death in African American and Hispanic women ages 15 to 24 and the sixth leading cause of death for African American and Hispanic women ages 25 to 34. Patients of color, including Hispanics with SLE, have significantly higher rates of lupus nephritis and are also at increased risk of developing end stage renal disease. African American and Hispanic women with SLE also tend to suffer from greater pregnancy complications, which can affect both the health of the mother and the unborn child.
Although the increased incidence and mortality of lupus in women and minority populations have been attributed to genetic factors, it is clear that the biology of the individual does not fully explain the disparities that characterize this disease. In recent years, important evidence has emerged on the role of social determinants of health in the disparities that characterize SLE.
What are social determinants of health? How does this affect the Hispanic/Latino communities?
According to the World Health Organization, the social determinants of health are "the conditions in which people are born, grow, work, live and age." These multiple factors explain, at least in part, health inequalities. For example, in Latino communities with lupus, social determinants of health may influence the course of the disease, increasing the risk of more severe disease with higher organ damage and mortality.
What role does income play in the social determinants of health?
Social determinants of health including income, health insurance status and distance to the nearest provider, greatly influence both access to health services and affordability of medications and the disease management among Latino patients. Therefore, low-income, unemployed or undocumented people are the most deeply affected. In addition, language barriers and cultural differences contribute both to patients' mistrust of their physicians and providers, and to the difficulties Latino patients often face in navigating the U.S. healthcare system. All this can lead to a delay in seeking medical care and receiving appropriate treatment, with multiple negative consequences on the outcomes of the disease. This is compounded by implicit bias and discrimination towards minority groups, by health care providers and society in general. Thus, Hispanic or Latino patients tend to have fewer social support resources, including culturally competent information about the disease and instrumental support, both of which are necessary for medical care to be early, appropriate and sustained.
What can organizations serving the lupus community do to address health disparities and social determinants of health?
Understanding disparities is essential to define public health policies. Therefore, organizations that serve the lupus community must be aware of the disparities that exist in the Hispanic population with lupus. In addition, it is essential that these organizations advocate for research on the roots of disparities and their consequences on individuals and society, so that health policies can be advocated and effective interventions to mitigate them can be promoted.
Dr. Cristina Drenkard is a retired Professor of Medicine at the Emory University School of Medicine in Atlanta, Georgia. Her research focused on lupus health disparities and helping people better manage their lupus. Dr. Drenkard is the director of Let's Talk About Lupus (“Hablemos de Lupus/Falando de Lúpus”), an online education program in Spanish and Portuguese for Latin American people with lupus and their caregivers.
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