Authors: Kiana Wells, Meghan Etsey, Rosy Thachil, MD, MBA; Brianna Clark, DO on behalf of AMWA Gender Equity Task Force

Toni Braxton’s 2008 diagnosis of Systemic Lupus Erythematosus, or SLE, brought public attention to a disease that disproportionately affects women of color, particularly Black women. SLE is a chronic autoimmune illness capable of damaging multiple organ systems, including the cardiovascular system. Cardiovascular disease is the leading cause of death among people with lupus, and the risks of myocardial infarction and stroke are significantly higher among lupus patients, especially young Black and Hispanic or Latina women (Taylor et al., 2022; Medha Barbhaiya et al., 2018). In Braxton’s case, lupus-related inflammation contributed to serious cardiac complications and the eventual diagnosis of coronary artery disease, illustrating how lupus can progress to life-threatening outcomes when cardiovascular risks are not identified early (Toni Braxton Opens up about Her Lupus Complications ahead of Lupus Awareness Month, 2023).

Social Determinants of Health

Disparities in lupus outcomes are driven in large part by social determinants of health. Access to subspecialty care remains a major barrier. Many Black and Hispanic patients live in areas with limited access to rheumatologists and cardiologists, often referred to as rheumatology or cardiology deserts. This lack of access delays diagnosis by years, allowing disease activity to worsen and increasing the likelihood of irreversible organ damage by the time treatment begins (Medha Barbhaiya et al., 2018).

Poverty and lack of insurance or underinsurance further compound these delays. Without consistent coverage, patients may postpone appointments, forgo diagnostic testing, or struggle to afford medications. These barriers disproportionately affect Black and Hispanic communities and directly interfere with effective lupus management (Hasan et al., 2022). Neighborhood and environmental conditions also contribute to poorer outcomes. Limited transportation, pharmacy access, exposure to environmental pollutants, and food insecurity create chronic stress and make ongoing healthcare engagement difficult (Hasan et al., 2022).

These challenges are intensified by intersectionality. Lupus primarily affects women, and women of color experience more severe disease and worse outcomes. The combined effects of racism and sexism shape exposure to stress, access to care, and the likelihood that symptoms are taken seriously. This intersection of social identities creates unique and compounding disadvantages that cannot be explained by race or gender alone (Hasan et al., 2022).

Health Systems Issues and Bias

Health system-level inequities further worsen outcomes for women of color with lupus. Implicit bias among healthcare providers contributes to the underdiagnosis and misattribution of lupus symptoms. Symptoms such as fatigue, chest pain, and shortness of breath are common in both lupus and cardiovascular disease, yet they are more likely to be minimized or dismissed in Black women. This leads to delays in referral to rheumatology or cardiology, allowing disease progression to continue untreated (Taylor et al., 2022).

Beyond implicit bias, women of color are also directly exposed to racism and sexism within healthcare settings. Reports of being dismissed, talked over, or not believed are common and contribute to reduced trust in clinicians and delayed care seeking. Chronic exposure to discrimination increases psychological stress and allostatic load, which worsens inflammatory and cardiovascular disease outcomes over time. Racism and sexism operate together within healthcare systems, reinforcing patterns of inequitable treatment and poorer health outcomes for women of color with lupus (Hasan et al., 2022).

A lack of diversity within medical specialties, particularly cardiology, represents another critical barrier. Cardiology remains one of the least diverse medical fields, with Black women significantly underrepresented. This lack of representation has implications beyond workforce numbers. It influences clinical training, research priorities, and how cardiovascular risk is recognized and managed in populations that do not match the historical norm of cardiac patients. When cardiology research and practice are centered on male and white populations, atypical presentations of cardiovascular disease in women of color with lupus are more likely to be overlooked or misinterpreted. Increasing diversity in cardiology is therefore not only an equity issue but also a clinical necessity for improving diagnostic accuracy and patient outcomes (Medha Barbhaiya et al., 2018; Taylor et al., 2022).

Delayed diagnosis often leads to undertreatment. Patients of color are less likely to receive aggressive disease management or timely referrals to subspecialists. This issue is further exacerbated by the high cost of many lupus-specific medications. Newer therapies are often prohibitively expensive, and access is closely tied to insurance status, reinforcing disparities rooted in socioeconomic inequality (Sun et al., 2020; Hasan et al., 2022).

Structural neglect is also evident in medical research funding. Lupus remains significantly underfunded relative to its disease burden, particularly when compared to conditions that predominantly affect men. This underinvestment limits the development of targeted therapies and reduces attention to how lupus uniquely affects women of color. Importantly, while Black lupus patients in the United States experience higher rates of organ damage, this disparity is not consistently observed among Black patients in other countries. This pattern underscores that U.S.-specific social and structural inequities, rather than biological differences, drive these outcomes (Hasan et al., 2022).

The disproportionate burden of lupus and cardiovascular disease among women of color reflects intersecting failures across social systems, healthcare institutions, and medical research. Addressing these disparities will require earlier and more aggressive screening, expanded access to subspecialty care, increased diversity in fields such as cardiology, greater research investment, and explicit efforts to confront racism and sexism within healthcare systems.

Toni Braxton’s willingness to publicly share her experience with lupus and its cardiac complications has helped raise awareness of a disease that is often misunderstood and underrecognized, particularly among women of color. Her advocacy highlights the need to move beyond individual stories toward systemic change. Improving outcomes for women of color with lupus will require not only awareness but also structural reforms that ensure timely diagnosis, equitable care, and representation within the medical fields responsible for treating this disease.

References:

Barbhaiya, M., Feldman, C. H., Guan, H., Chen, S. K., Fischer, M. A., Solomon, D. H., Everett, B. M., & Costenbader, K. H. (2019). Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus. Seminars in Arthritis and Rheumatism, 48(5), 840–846. https://doi.org/10.1016/j.semarthrit.2018.07.012

Hasan, B., Fike, A., & Hasni, S. (2022). Health disparities in systemic lupus erythematosus—a narrative review. Clinical Rheumatology, 41(11), 3299–3311. https://doi.org/10.1007/s10067-022-06268-y

Sun, K., Eudy, A. M., Criscione‐Schreiber, L. G., Sadun, R. E., Rogers, J. L., Doss, J., Corneli, A. L., Bosworth, H. B., & Clowse, M. E. B. (2020). Racial Disparities in Medication Adherence between African American and Caucasian Patients With Systemic Lupus Erythematosus and Their Associated Factors. ACR Open Rheumatology, 2(7), 430–437. https://doi.org/10.1002/acr2.11160

Taylor, T., Anastasiou, C., Ja, C., Rush, S., Trupin, L., Dall’Era, M., Katz, P., Barbour, K. E., Greenlund, K. J., Yazdany, J., & Gianfrancesco, M. A. (2022). Causes of Death Among Individuals With Systemic Lupus Erythematosus by Race and Ethnicity: A Population‐Based Study. Arthritis Care & Research, 75(1), 61–68. https://doi.org/10.1002/acr.24988

Toni Braxton Opens Up About Her Lupus Complications Ahead of Lupus Awareness Month. (2023). Lupus Foundation of America. https://www.lupus.org/blog/toni-braxton-opens-up-about-her-lupus-complications

About the Authors

Kiana Wells, MS, MS3

Kiana Wells is a third-year medical student from St. George’s University. She holds a Bachelor of Arts in Independent Studies with a focus on Neuroscience from Berea College in Berea, Kentucky. As well as a Master of Science in Medical Sciences from Ponce Health Sciences University in St. Louis, Missouri. She served as the Vice President of Pink Run in the St. George’s University Women in Medicine chapter in St. George, Grenada, where she expanded relationships with the community and worked towards fundraising money for women to receive screenings and treatment for breast cancer. She was also a member of the St. George’s University Cheerleading team, supporting fellow colleagues in their love for movement and teamwork. Beyond medicine, she is passionate about providing resources for underserved communities, with projects like Lasagna Love. She also enjoys taking a Pilates class, weightlifting, or watching a comfort show for the 100th time. 

Meghan Etsey, MS4

Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world. 

Rosy Thachil, MD, FACC, co-chair of AMWA’s Gender Equity Task Force, is a quadruple board-certified cardiologist, serving as Director of the Cardiac Intensive Care Unit at Elmhurst Hospital Center, and Assistant Professor at Mount Sinai College of Medicine in New York. Dr. Thachil’s clinical interests include critical care cardiology/acute cardiovascular care and health disparities. In addition to addressing cardiovascular disease, she is passionate about advancing women’ s roles in medicine/leadership. She also serves on the American College of Cardiology Critical Care Leadership Council and she is a candidate at Wharton’s executive MBA program (‘25), and holds certificates in physician leadership and bioethics.

Dr. Brianna Clark is a proud osteopathic physician.  She has completed fellowships in Breastfeeding Medicine at the University of Rochester Lessons in Lactation Advanced Curriculum ( LILAC) and Climate Health Equity Fellowship ( CHEF) through the National Medical Association ( NMA). She spends her spare time thinking about innovative ways to provide equitable health care to all and create sustainable advocacy. 

Formatting, publication management, and editorial support for the AMWA GETF Blog by Vaishnavi J. Patel, DO