{
  "abstract": "Objectives Systemic lupus erythematosus (SLE) is a complex autoimmune disease with heterogeneous clinical manifestations. Evidence from high-income countries suggests that socioeconomic status (SES) and environmental factors influence SLE outcomes, yet data from Latin America remain limited. The objective of this research was to evaluate, across three levels (individual, regional, national), whether socioeconomic and environmental factors impact the clinical presentation of SLE in the GLADEL 2.0 cohort.Methods We analyzed data from 1,083 patients with SLE enrolled in the GLADEL 2.0 cohort across 10 Latin American countries. All patients fulfilled the 1982/1997 American College of Rheumatology (ACR) or 2012 Systemic Lupus International Cooperating Clinics (SLICC) classification criteria. Clinical outcomes were disease activity (SLEDAI-2K), organ involvement (renal, hematologic, cutaneous, musculoskeletal), and organ damage (SLICC/ACR damage index; SDI). Variables were structured into three levels: Level 1 (individual), Level 2 (state/province), Level 3 (national). Multilevel analyses included sociodemographic variables, environmental exposure to air pollutants (PM2.5, PM10, NO2), and contextual indicators (income, unemployment, distribution of income or wealth through the Gini index, CO2 emissions). Statistical analysis included cluster analysis (Ward’s method) and principal component analysis (PCA).Results Five clusters emerged based on socioeconomic and environmental determinants. Cluster two (urban, high-income, low inequality) exhibited low damage (SDI [mean±SD] 0.66±0.9) and high disease activity (SLEDAI [mean±SD] 13.0±9.2). Conversely, Cluster four (middle-low SES, high inequality, high NO2 exposure) demonstrated high disease impact (SDI [mean±SD] 1.06±1.4) and greatest work productivity loss (36.1%). Cluster three (low-income, low pollution) presented the highest accumulated damage (mean SDI [mean±SD] 1.73±1.95). Environmental exposures varied significantly; Cluster five showed the highest CO2 emissions and solar irradiance, while Cluster three had the lowest environmental burden. PCA showed that clinical manifestations, disease activity and chronicity were different across clusters. The figure highlights the separation of the characteristics according to the three principal components.Abstract PO:07:188 Figure 1Three-dimensional representation of the first three principal components, showing the five clusters of SLE patients derived from socioeconomie and environmental variablesConclusions Socioeconomic and environmental factors at the individual, regional, and national levels influence the cumulative clinical manifestations and patient-reported outcomes in SLE. Our findings underscore the role of social vulnerability and environmental stressors as potential modifiers of SLE phenotype in Latin America, highlighting the need for context-sensitive interventions and policies to mitigate health inequities.",
  "authors": [
    {
      "affiliations": [
        "Centro Regional de Enfermedades Autoinmunes y Reumáticas, GO-CREAR, Rosario, Argentina"
      ],
      "name": "Romina Nieto"
    },
    {
      "affiliations": [
        "HGSZ No 9, Instituto Mexicano del Seguro Social, San Luis Potosí, México"
      ],
      "name": "Marco Ulises Martínez Martínez"
    },
    {
      "affiliations": [
        "Instituto de Investigación, Rosario, Argentina"
      ],
      "name": "Karen Roberts"
    },
    {
      "affiliations": [
        "Centro Regional de Enfermedades Autoinmunes y Reumáticas, GO-CREAR, Rosario, Argentina"
      ],
      "name": "Rosana Quintana"
    },
    {
      "affiliations": [
        "Hospital Italiano de Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Marina Scolnik"
    },
    {
      "affiliations": [
        "Hospital Italiano de Córdoba, Córdoba, Argentina"
      ],
      "name": "Carmen Funes Soaje"
    },
    {
      "affiliations": [
        "Hospital Córdoba y Sanatorio Allende, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina"
      ],
      "name": "Paula Alba"
    },
    {
      "affiliations": [
        "Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina"
      ],
      "name": "Verónica Saurit"
    },
    {
      "affiliations": [
        "Hospital San Martin de La Plata, La Plata, Argentina"
      ],
      "name": "Mercedes Argentina García"
    },
    {
      "affiliations": [
        "Sanatorio Británico, Rosario, Argentina"
      ],
      "name": "Guillermo A Berbotto"
    },
    {
      "affiliations": [
        "Hospital Padilla, Tucumán, Argentina"
      ],
      "name": "Verónica Bellomio"
    },
    {
      "affiliations": [
        "Hospital J.M Ramos Mejía, Buenos Aires, Argentina"
      ],
      "name": "Eduardo Mario Kerzberg"
    },
    {
      "affiliations": [
        "Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Graciela Noemí Gómez"
    },
    {
      "affiliations": [
        "CEMIC Centro de Educación Médica e Investigaciones Clínicas ‘‘Norberto Quirno’, Buenos Aires, Argentina"
      ],
      "name": "Cecilia Nora Pisoni"
    },
    {
      "affiliations": [
        "Hospital Señor del Milagro Salta, Salta, Argentina"
      ],
      "name": "Vicente Juárez"
    },
    {
      "affiliations": [
        "Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina"
      ],
      "name": "Ana Malvar"
    },
    {
      "affiliations": [
        "Hospital das Clinicas da Universidade Federal de Goias, Goias, Brazil"
      ],
      "name": "Nilzio Antonio Da Silva"
    },
    {
      "affiliations": [
        "Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil"
      ],
      "name": "Odirlei Andre Monticielo"
    },
    {
      "affiliations": [
        "Universidad Federal de Pernambuco, Pernambuco, Brazil"
      ],
      "name": "Henrique Ataide Mariz"
    },
    {
      "affiliations": [
        "Hospital Universitário Pedro Ernesto—Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil"
      ],
      "name": "Francinne Machado Ribeiro"
    },
    {
      "affiliations": [
        "Faculdade de Medicina da Universidade de São Paulo, USP, São Paulo, Brazil"
      ],
      "name": "Eduardo F Borba"
    },
    {
      "affiliations": [
        "Faculdade de Medicina da Universidade de São Paulo, USP, São Paulo, Brazil"
      ],
      "name": "Eloisa Bonfa"
    },
    {
      "affiliations": [
        "Escola Paulista de Medicina/Universidade federal de São Paulo (EPM/Unifesp), Sao Paulo, Brazil"
      ],
      "name": "Edgard Torres Dos Reis-Neto"
    },
    {
      "affiliations": [
        "Hospital del Salvador Santiago de Chile, Santiago, Chile"
      ],
      "name": "Iris Guerra Herrera"
    },
    {
      "affiliations": [
        "Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile"
      ],
      "name": "Loreto Massardo"
    },
    {
      "affiliations": [
        "Clínica de la Costa y Universidad Simón Bolívar, Barranquilla, Colombia"
      ],
      "name": "Gustavo Aroca Martínez"
    },
    {
      "affiliations": [
        "Clínica de la Costa y Universidad Simón Bolívar, Barranquilla, Colombia"
      ],
      "name": "Lorena Gómez Escorcia"
    },
    {
      "affiliations": [
        "Fundación Valle del Lili, Universidad Icesi, Cali, Colombia"
      ],
      "name": "Carlos A Cañas"
    },
    {
      "affiliations": [
        "Facultad de Medicina, Universidad Nacional de Colombia",
        "Hospital Universitario Fundación Santa Fe de Bogotá",
        "Hospital Universitario Nacional de Colombia, Bogotá, Colombia"
      ],
      "name": "Gerardo Quintana-Lopez"
    },
    {
      "affiliations": [
        "Pontificia Universidad Javeriana de Cali, Cali, Colombia"
      ],
      "name": "Carlos Enrique Toro Gutiérrez"
    },
    {
      "affiliations": [
        "Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador"
      ],
      "name": "Mario Javier Moreno Alvarez"
    },
    {
      "affiliations": [
        "Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico"
      ],
      "name": "Miguel Ángel Saavedra"
    },
    {
      "affiliations": [
        "Hospital de Especialidades del Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico"
      ],
      "name": "Margarita Portela Hernández"
    },
    {
      "affiliations": [
        "Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico"
      ],
      "name": "Hilda Fragoso-Loyo"
    },
    {
      "affiliations": [
        "Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico"
      ],
      "name": "Luis H Silveira"
    },
    {
      "affiliations": [
        "Centro de Estudios de Investigación Básica y Clínica, S.C., Jalisco, Mexico"
      ],
      "name": "Ignacio García De La Torre"
    },
    {
      "affiliations": [
        "Facultad de Medicina de la Universidad Autónoma de San Luis Potosí y Hospital Central ‘Dr. Ignacio Morones Prieto’, San Luis Potosí, Mexico"
      ],
      "name": "Carlos Abud-Mendoza"
    },
    {
      "affiliations": [
        "Hospital Universitario ‘Dr. José Eleuterio Gonzalez’, Universidad Autónoma de Nuevo León, Nuevo León, Mexico"
      ],
      "name": "Jorge A Esquivel Valerio"
    },
    {
      "affiliations": [
        "Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay"
      ],
      "name": "Isabel Acosta Colman"
    },
    {
      "affiliations": [
        "Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay"
      ],
      "name": "Astrid Paats"
    },
    {
      "affiliations": [
        "Hospital Nacional Edgardo Rebagliati Martins-EsSalud, Lima, Peru"
      ],
      "name": "Claudia Mora Trujillo"
    },
    {
      "affiliations": [
        "Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Lima, Peru",
        "Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru"
      ],
      "name": "Manuel F Ugarte-Gil"
    },
    {
      "affiliations": [
        "Hospital Nacional Cayetano Heredia Universidad Peruana Cayetano Heredia, Lima, Peru"
      ],
      "name": "Armando Calvo Quiroz"
    },
    {
      "affiliations": [
        "Hospital Docente Padre Billini, Distrito Nacional, Dominican Republic"
      ],
      "name": "Roberto Muñoz Louis"
    },
    {
      "affiliations": [
        "Hospital de Clínicas, Facultad de Medicina, UDELAR, Montevideo, Uruguay"
      ],
      "name": "Martín Rebella"
    },
    {
      "affiliations": [
        "Médica Uruguaya, Facultad de Medicina—Universidad de la República, Montevideo, Uruguay"
      ],
      "name": "Álvaro Danza"
    },
    {
      "affiliations": [
        "Rheumatology Department, Hospital Clinic, Barcelona, Spain"
      ],
      "name": "José A Gómez-Puerta"
    },
    {
      "affiliations": [
        "Johnson and Johnson, Horsham, PA"
      ],
      "name": "Federico Zazzetti"
    },
    {
      "affiliations": [
        "Johnson and Johnson, Spring House, PA"
      ],
      "name": "Ashley Orillion"
    },
    {
      "affiliations": [
        "Centro Regional de Enfermedades Autoinmunes y Reumáticas, GO-CREAR, Rosario, Argentina"
      ],
      "name": "Guillermo Pons-Estel"
    },
    {
      "affiliations": [
        "Hospital General de México ‘Dr. Eduardo Liceaga’, Mexico City, Mexico"
      ],
      "name": "Ingris Peláez-Ballestas"
    }
  ],
  "title": "PO:07:188 Cluster analysis of socioeconomic and environmental determinants modifying activity, chronicity and clinical manifestations of systemic lupus erythematosus in the GLADEL 2.0 cohort",
  "uid": "cb8d404e-0ea0-55c4-8546-94d1962f9509"
}