{
  "abstract": "Background SLE is a chronic autoimmune disease with heterogeneous manifestations and variable outcomes. Geographic factors such as rural residence may influence disease severity, access to care and treatment adherence, yet evidence remains fragmented. This systematic review aimed to evaluate the impact of rurality on clinical outcomes in adults with SLE.Methods We systematically searched PubMed, Embase and Web of Science for observational studies published up to May 2025 that assessed the association between rural residence and clinical outcomes in SLE. Eligible studies included adult patients with SLE and reported at least one relevant outcome stratified by rurality. Using the Newcastle-Ottawa Scale, data were extracted on study characteristics, definitions of rurality, outcome domains and risk of bias. Due to heterogeneity in study design and outcomes, a narrative synthesis was conducted.Results Eight studies, including over 34 000 participants from the USA, Greece, China, Egypt, Puerto Rico and Latin America (Grupo Latino Americano de Estudio del Lupus cohort), met inclusion criteria. Definitions of rurality varied widely, encompassing administrative classifications, demographic thresholds and self-reported residence. Rural residence was often associated with delayed diagnosis, higher disease activity, lower physical quality of life, increased hospital readmissions and poorer medication adherence. Survival findings were mixed, and one study found no rural disadvantage where specialised care was available. Methodological quality was generally moderate to high.Conclusion Across diverse settings, rural SLE populations frequently experience worse outcomes, although this is not universal and appears to be strongly influenced by structural disadvantages rather than geography alone. Standardised definitions of rurality and multidimensional measurement approaches are needed to improve comparability and guide effective interventions. Targeted strategies—such as telemedicine, outreach programmes and policies addressing healthcare access—may help reduce inequities in SLE care.",
  "authors": [
    {
      "affiliations": [
        "Department of Community Care, Unnan City Hospital, Unnan, Japan",
        "Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan",
        "Community Medicine Management, Shimane University Faculty of Medicine, Izumo, Japan"
      ],
      "name": "Ryuichi Ohta"
    },
    {
      "affiliations": [
        "Department of Community Care, Unnan City Hospital, Unnan, Japan",
        "Community Medicine Management, Shimane University Faculty of Medicine, Izumo, Japan"
      ],
      "name": "Ryu Yoshinori"
    },
    {
      "affiliations": [
        "Community Medicine Management, Shimane University Faculty of Medicine, Izumo, Japan"
      ],
      "name": "Chiaki Sano"
    },
    {
      "affiliations": [
        "Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan"
      ],
      "name": "Kunihiro Ichinose"
    }
  ],
  "title": "Impact of rural residence on clinical outcomes in SLE: a systematic review",
  "uid": "ebe4ab82-6b31-50bc-a5c4-8f16dcb619e5"
}