Gender, Ethnicity and Lupus

A Look at the Lumina Study

While systemic lupus erythematosus (SLE) affects men and women of all ages, the scale shifts heavily toward women—and even more so towards minorities. There are several leading factors, details of which continue to reveal themselves through a groundbreaking report called "Lupus in Minorities: Nature Versus Nurture," or the LUMINA study.

A nurse comforting her patient
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Recap: Who Gets Lupus

According to the Lupus Foundation of America, out of the 1.5 million Americans affected with some form of lupus, 90% of those diagnosed are women, the vast majority of whom are between 15 to 45 years old. However, anywhere between 4% and 25% of lupus patients have late-onset lupus, which can occur after age 50. 

Furthermore, according to the CDC, lupus is two to three times more prevalent among people of color, including African Americans, Hispanic people, Asians, and American Indians. In minorities, lupus often presents much earlier and with worse than average symptoms as well as a higher death rate. Specifically, the death rate of people with lupus is nearly three times higher for African Americans than whites.

The CDC further reports there is an increased prevalence of kidney problems as well as cardiac disease in Hispanic women with lupus and an increased incidence of such as seizures, stroke, and swelling of the heart among African-American women with lupus.

The question is, why such disparity?

The LUMINA Study

In 1993, medical researchers set out to determine why there was such disparity between lupus in Whites and lupus in people of color. Those researchers focused on the question of nature versus nurture. The result was The LUMINA Study.

The LUMINA Study was a multiethnic United States early cohort, meaning researchers studied various ethnicities—in this case, African-Americans, Caucasians, and Hispanics—from the United States who were diagnosed with lupus for 5 years or fewer. A cohort study is a form of longitudinal study used in medicine and social science.

Some nurture factors related to disparity among study participants included the following:

  • Communication barriers (such as language differences)
  • Lack of access to care
  • Lack of healthcare coverage
  • Lower income levels

What researchers discovered early on was that genetic and ethnic factors, or nature factors, play a larger role in determining lupus prevalence than socioeconomic nurture factors. Furthermore, the study suggests that genetics may be the key that unlocks the reason why lupus affects African Americans and Hispanic women more than other people of color.

Further findings from the LUMINA study:

  • Lupus patients of Hispanic and African-American descent have more active diseases at the time of diagnosis, with more serious organ system involvement.
  • Whites were of higher socioeconomic status and older than either Hispanic people or African Americans.
  • Important predictors of disease activity in these two minority groups were variables such as abnormal illness-related behaviors.
  • As time passed, the total damage became worse for the two minority groups than that for the whites, although the differences were not statistically significant.
  • Disease activity also has emerged as an important predictor of death for this group of patients. Consistent with lower disease activity, Whites exhibited lower mortality rates than Hispanic people or African Americans.

Ten years after the LUMINA study

In 2003, scientists revisiting the LUMINA study 10 years later came to even more interesting conclusions:

  • Lupus presents itself more severely in African Americans and Hispanics from Texas than it does in Whites and Hispanics from Puerto Rico.
  • Those patients who lacked health insurance experienced acute lupus onset and expressed certain genetics (HLA-DRB1*01 (DR1) and C4A*3 alleles) had more severe lupus.
  • The severity of damage to organs stemming from lupus or the adverse effects of lupus could be predicted based on age, the number of American College of Rheumatology criteria met, disease activity, corticosteroid use, and abnormal illness behaviors.
  • Most revealing: One of the key factors in determining mortality was where a person stood financially with respect to poverty. People with lupus who were poorer financially were more apt to die of lupus or complications stemming from the disease, in part because of limited access to healthcare.

Information from the 10-year study will be used to delve further into the nature or nurture question and may yield new ways of focusing on and eliminating health disparities in the United States.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Drenkard C, Lim SS. Update on lupus epidemiology: advancing health disparities research through the study of minority populations. Current Opinion in Rheumatology. 2019;31(6):689-696. doi. 10.1097/bor.0000000000000646. Published November, 2019.

  2. Uribe AG, McGwin G, Reveille JD, Alarcón GS. What have we learned from a 10-year experience with the lumina (Lupus in minorities; nature vs. Nurture) cohort? Where are we heading? Autoimmunity Reviews. 2004;3(4):321-329. doi. 10.1016/j.autrev.2003.11.005. Published in June, 2004.

Additional Reading
  • What Have We Learned From a 10-Year Experience With the Image (Lupus in Minorities; Nature vs. Nurture) Cohort? Where Are We Heading? Autoimmunity Reviews, Volume 3, Issue 4, June 2004, Pages 321-329. América G. Uribe, Gerald McGwin, John D. Reveille and Graciela S. Alarcón.

  • Demographics on Lupus Lupus Foundation of America. December 2007.
  • Do Patients of Hispanic and African-American Ethnicity with Lupus Experience Worse Outcomes than Patients with Lupus from Other Populations? The LUMINA Study Lupus Foundation of America. September 1999.
  • Who Gets Lupus? Lupus Research Institute. December 2007.

By Jeri Jewett-Tennant, MPH
Jeri Jewett-Tennant, MPH, is a medical writer and program development manager at the Center for Reducing Health Disparities.