{
  "abstract": "Objectives Individuals with systemic lupus erythematous (SLE) often have heat- and photo- sensitivity, making them particularly vulnerable to environmental heat exposure. While environmental heat has been associated with SLE-related disease flares and hospitalization, the association between extreme heat exposure and incident SLE and how it may be impacted by socioeconomic factors remains unknown.Methods We use data from the Sister Study, a prospective cohort of US women (enrollment: 2003-2009; ages: 35-74). Eligible participants (N=48,934) had no prior SLE history. Incident SLE was self-reported during follow-up through October 2022. PRISM weather data were obtained at 4km resolution and linked to enrollment residence to estimate single year and 3-year average daily maximum apparent temperature (i.e., heat index) and the total number of hot days that exceeded 85 degrees Fahrenheit (F). We use Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for SLE associated with quartile differences in heat measures. We explored effect measure modification by educational attainment—a proxy for resource availability to potentially mitigate heat exposure.Results Over follow-up (672,477 person years), 395 participants reported incident SLE (mean age at diagnosis: 61+/-10 years) with an average time to diagnosis of 6.4 years. Increasing quartiles of environmental residential heat were associated with greater SLE hazard. Individuals in areas with the highest quartile of 3-year average daily apparent temperature had 1.35 (CI:1.00, 1.82) times greater SLE hazard than those living in the lowest quartile. Similarly, SLE hazard was also associated with living in areas in the highest quartile of 3-year average annual days over 85F (HR:1.40; CI:1.04, 1.89). Single year associations were similar in magnitude and trend. When stratified by educational attainment, participants who reported less than a bachelor’s degree and lived in areas in the highest quartile of 3-year average annual days over 85F had 1.47(CI:1.00, 2.16) times greater SLE hazard compared to the lowest quartile.Conclusions Environmental heat exposure was associated with increased SLE hazard. Associations were slightly modified by educational attainment, a proxy for potential socioeconomic resources available to mitigate heat exposure. Environmental heat exposure should be further assessed as a potential SLE risk factor.",
  "authors": [
    {
      "affiliations": [
        "National Institute of Environmental Health Sciences, Durham, NC, USA"
      ],
      "name": "Jennifer Woo"
    },
    {
      "affiliations": [
        "DLH Corp, Durham, NC, USA"
      ],
      "name": "Kaitlyn Lawrence"
    },
    {
      "affiliations": [
        "National Institute of Environmental Health Sciences, Durham, NC, USA",
        "DLH Corp, Durham, NC, USA"
      ],
      "name": "Dale Sandler"
    }
  ],
  "title": "PO:07:178 Environmental heat exposure and risk of systemic lupus erythematosus",
  "uid": "3951ccd7-e9fa-59fc-8c2e-03b297bb0886"
}