Neighborhood-level area deprivation influences disease phenotype in adult-onset dermatomyositis

Summary: Abstract Body: The impact of neighborhood-level social determinants of health on disease characteristics in adult-onset dermatomyositis (DM) remains unexplored. In this study, we used the area deprivation index (ADI) to identify associations between neighborhood-level disadvantage and cutaneous and extracutaneous DM characteristics. We retrospectively reviewed the medical records of Maryland residents with adult-onset DM who were evaluated by dermatologists at Johns Hopkins Hospital between 2011 and 2024. Data collected included demographic information, smoking history, malignancy status, DM characteristics, and myositis-specific antibody (MSA) profile. State ADI was determined using each patient’s documented home address. Univariate and multivariate analyses, adjusted for ADI, race, sex, age at diagnosis, malignancy, and smoking history, were conducted. Ninety-five patients were included in the analysis (mean [SD] age 50.7 [15.4] years; 76 (80%) female; 30 (31.6%) Black; 57 (60%) Non-Hispanic White). Patients residing in areas with a higher ADI were more likely to be Black (p<0.001), and to have interstitial lung disease (ILD) (p=0.003), myositis (p=0.01), and arthritis or arthralgia (p=0.01). Conversely, patients in areas with a lower ADI were more likely to exhibit cutaneous manifestations such as V-neck sign (p=0.02) and periungual erythema or nailfold changes (p=0.004). Additionally, lower ADI was associated with higher peak Cutaneous Dermatomyositis Disease Area and Severity Index Activity scores (p=0.04). Following multivariate adjustment, higher ADI emerged as the sole predictor of DM-associated ILD (p=0.04) and myositis (p=0.039) and remained significantly associated with arthritis or arthralgia (p=0.037). Conversely, lower ADI was the only significant predictor of the presence of V-neck sign (p=0.027) and periungual erythema (p=0.004). Our findings emphasize the importance of considering DM patients' socioeconomic context during evaluation, as ADI emerged as a key factor influencing specific disease outcomes, surpassing race as a determinant after multivariable adjustment. Saloni Patel¹, Ruchita Kothari¹, Maria Kaltchenko¹, Jun Kang¹ 1. Dermatology, Johns Hopkins Medicine, Baltimore, MD, United States. Minoritized Populations and Health Disparities Research