Dubois Lecture to Focus on Reducing Inequities in SLE Care and Outcomes

There are profound inequities in the diagnosis, care, and outcomes for individuals living with systemic lupus erythematosus (SLE). Differences in geography, race, ethnicity, and socioeconomic status drive disparities in access to care, delivery of care, and outcomes. But inequities in care are not fixed forever. Just as healthcare providers and systems of the past and present created and continue to reinforce inequities, healthcare providers and systems of today can play a critical role working to reverse them.

During her 2024 Dubois Memorial Lecture, Building a More Equitable Future in Lupus Care and Outcomes, on Saturday, Nov. 16, Candace H. Feldman, MD, MPH, ScD, Assistant Professor of Medicine and Director of Diversity and Health Equity Research in the Division of Rheumatology, Inflammation and Immunity at Brigham and Women’s Hospital and Harvard Medical School, will explore the roots of inequities in lupus care and mechanisms being designed and implemented to reduce those inequities.

The session will take place from 3–4 p.m. ET in Room 144ABC of the Walter E. Washington Convention Center and will be available on demand within 48 hours for registered ACR Convergence 2024 participants.

“I initially trained in primary care and public health and became struck as a resident by the inequities I was seeing in hospitalizations and adverse outcomes, particularly among patients with lupus,” Dr. Feldman said. “I repeatedly encountered young individuals who had terrible manifestations of lupus, and these adverse outcomes seemed so avoidable. What led me to become a rheumatologist was trying to understand these inequities in the outcomes that should never have happened in the first place and understanding the social factors that may have contributed. There are structures in place in our society and in our healthcare system that make it impossible for people to obtain the healthcare they need.”

Inequities in care are pervasive, she said, and individual rheumatologists can actively participate in efforts to improve outcomes by changing the ways in which they interact with patients on a day-to-day basis.

“Any one individual and any one intervention obviously will not fix the entirety of the problem,” Dr. Feldman said. “But there are many levels and layers to how we can begin to improve care now for our patients while simultaneously advocating for changes to the healthcare system and societal structures so these inequities narrow.”

Screening for social needs and intervening to help patients access transportation, medication, and food can transform the care clinicians provide. And rheumatologists can think on a broader scale about ways to partner with patients, communities, and administrators to change the social and healthcare system structures that continue to drive inequities, Dr. Feldman said.

Rheumatology providers should also reflect on the biases that all individuals bring and consider ways to reduce reliance on stereotypes, which will build trust and improve the quality of care delivered. Many rheumatologists are acutely aware of the inequities that exist, added Dr. Feldman. They see them every day, they think about them, they study them, and they develop strategies to reduce them.

“And there are many rheumatologists for whom inequities are not in the forefront because there are so many other things we have to think about and consider as physicians and healthcare professionals and researchers,” Dr. Feldman said. “One of my goals is to plant the seed that these inequities will not get better without urgent, large-scale mobilization and action.

“We are not going to fix the entire system and all the structures that are driving these inequities tomorrow,” she continued. “But we can begin to advocate for those changes while we individually make direct changes in the way we are providing care that can improve outcomes for our patients today.”