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Lupus. 2019 Jan;28(1):104-113. doi: 10.1177/0961203318816820. Epub 2018 Dec 6.

Is systemic lupus erythematosus different in urban versus rural living environment? Data from the Cretan Lupus Epidemiology and Surveillance Registry.

Author information

1
1 Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Greece.
2
2 Laboratory of Autoimmunity and Inflammation, Institute of Molecular Biology-Biotechnology, FORTH, Iraklio, Greece.
3
3 Rheumatology, Clinical Immunology, 4th Department of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
4
4 Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, Greece.
5
5 Institute for Environmental Research and Sustainable Development (IERSD), National Observatory of Athens (NOA), Athens, Greece.
6
6 Physikalisch-Meteorologisches Observatorium Davos, World Radiation Centre (PMOD/WRC), Davos, Switzerland.
7
7 Department of Social Medicine, University of Crete School of Medicine, Iraklio, Greece.
8
8 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA.
9
9 Department of Genetics & Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
10
10 Joint Rheumatology Programme, National and Kapodistrian University of Athens Medical School, Athens, Greece.
11
11 University of Cyprus, Medical School, Nikosia, Cyprus.
12
12 Biomedical Research Foundation of the Academy of Athens, Athens, Greece.

Abstract

BACKGROUND:

Examining urban-rural differences can provide insights into susceptibility or modifying factors of complex diseases, yet limited data exist on systemic lupus erythematosus (SLE).

OBJECTIVE:

To study SLE risk, manifestations and severity in relation to urban versus rural residence.

METHODOLOGY:

Cross-sectional analysis of the Crete Lupus Registry. Demographics, residency history and clinical data were obtained from interviews and medical records ( N=399 patients). Patients with exclusively urban, rural or mixed urban/rural residence up to enrolment were compared.

RESULTS:

The risk of SLE in urban versus rural areas was 2.08 (95% confidence interval: 1.66-2.61). Compared with rural, urban residence was associated with earlier (by almost seven years) disease diagnosis - despite comparable diagnostic delay - and lower female predominance (6.8:1 versus 15:1). Rural patients had fewer years of education and lower employment rates. Smoking was more frequent among urban, whereas pesticide use was increased among rural patients. A pattern of malar rash, photosensitivity, oral ulcers and arthritis was more prevalent in rural patients. Residence was not associated with organ damage although moderate/severe disease occurred more frequently among rural-living patients (multivariable adjusted odds ratio: 2.17, p=0.011).

CONCLUSION:

Our data suggest that the living environment may influence the risk, gender bias and phenotype of SLE, not fully accounted for by sociodemographic factors.

KEYWORDS:

Environment; autoimmune diseases; comorbidities; outcome; risk factors; urban

PMID:
30522399
DOI:
10.1177/0961203318816820
[Indexed for MEDLINE]

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