Effects of Ethnic and Social Factors

A greater incidence and prevalence of LE has consistently been found in blacks than in whites (Siegel and Lee 1973). A study in Birmingham, England, found higher age-adjusted incidence and prevalence rates in Afro-Caribbean people than in whites (Johnson et al. 1995). Incidence rates (age adjusted) were 25.8 and 4.3 cases per 100,000 persons per year in Afro-Caribbean people and whites, respectively, and prevalence rates were 112 and 21 cases per 100,000 persons. In this study, the age distribution of incidence cases differed significantly, with a younger median age in Afro-Caribbean females of 34.5 years compared with 41 years in white females. Some data also exist regarding an excess prevalence of LE in Asians compared with whites. In Birmingham (Johnson et al. 1995), the age-adjusted annual incidence and prevalence rates of LE in Asians were 20.7 and 46.7 cases per 100,000 persons, respectively, compared with 4.3 and 20.7 cases per 100,000 persons in whites, respectively.

The cases described in Africa until the past decade were very scarce. Although there are no good epidemiologic studies, currently it is considered that these differences could be attributed to the associated socioeconomic conditions that favor or hinder diagnosis and correct treatment. For example, since this disease affects fundamentally young women, with an age at onset of 15-40 years, it is possible that the incidence will be greater in countries with rapid population growth. Also, in countries and social groups with worse socioeconomic conditions, a more severe clinical presentation could be more frequent (Symmonds 1995).

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