PROJECT SUMMARY
Systemic lupus erythematous (SLE) is an inflammatory, autoimmune disease that disproportionally
burdens African American women with more rapid disease progression and worse outcomes compared to their
White counterparts. Increasing evidence suggests racial disparities in SLE progression are due in part to
disproportionate exposure to psychosocial stress, as well as qualitatively unique racial minority stressors,
which accelerate physiologic deterioration and may undermine shared inflammatory stress-response pathways
involved in the pathogenesis of SLE. Routine experiences of psychosocial stress are common in the lives of
African American women with SLE and can include stressors inherent with managing a chronic illness, in
addition to those stemming from community disadvantage and poverty. African American women also face
distinct forms of psychosocial stress, including experiences of racial discrimination and exposure to other race-
related stressors. Despite existing evidence, mechanisms for racial disparities in SLE progression are poorly
understood. To address these gaps in knowledge among African American women with SLE, this study aims
to: (1) examine understudied dimensions of race-related psychosocial stress in relation to disease activity and
organ damage; (2) examine the influence of area-level neighborhood characteristics and stressors on rates of
SLE progression; and (3) identify trajectories in biomarkers of inflammation relevant to SLE and identify high-
risk subgroups. Data for the proposed analyses are from the Black Women's Experiences Living with Lupus
(BeWELL) Study, one of the largest and most comprehensive studies on the social epidemiology of SLE. The
BeWELL Study represents a rigorous assessment of rich psychosocial factors, validated measures of disease
outcomes, and objective inflammatory biomarkers among an innovative population-based sample of African
American women with confirmed SLE (n=438) living in metropolitan Atlanta, Georgia. The proposed research
will leverage the strengths of the BeWELL Study and yield insight into specific pathways that may contribute to
the disproportionate rate of SLE progression experienced by African American women. We will investigate the
role of novel race-related psychosocial stressors on SLE outcomes, including “secondhand” or vicarious
exposure to racist incidents, subtle everyday slights or microaggressions, and anticipation of experiencing
racial threats. Multilevel analyses will examine the influence of spatial factors, specifically socioeconomic
disadvantage and racial residential segregation on SLE outcomes. Trajectories in inflammation will be
identified and explored in relation to sociodemographic, mental and physical health factors. Longitudinal
methodological approaches will be utilized to help support causal inference. Training activities throughout the
proposed fellowship will develop skill sets and enhance knowledge needed to conduct the intended analyses
and prepare for a career in research. Various opportunities for professional development and mentorship from
a diverse team of scholars will facilitate this goal.