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Blacks and other minorities continue to experience a greater rate of illness and death than the rest of the US population, and the experience with systemic lupus erythematosus (SLE) follows this trend. Health status in minorities is most strongly affected by socioeconomic status, nutritional status and dietary practices, environmental and occupational experience, and patterns of stress and coping. Some feel that socioeconomic status, although understudied, is the most important of these. The relationship of the rate of illness and death to socioeconomic status in blacks with SLE is reviewed. The epidemiology of the disease is reviewed, with particular attention to SLE in blacks and to genetic and environmental factors. Decreased survival in SLE is related to kidney impairment, brain involvement, anemia, low platelet levels, and race. Health outcome in other chronic diseases is influenced by socioeconomic status regardless of race. This status is, in turn, associated with other factors, such as access to quality health care, understanding of the disease and compliance with treatment, opportunities to continue meaningful occupations and activities, and interventions to enhance self-confidence and social support. The relationship between poverty and health is complex and would be difficult to modify by programs unless the roots of poverty are addressed. However, resulting disability and disease severity from other chronic diseases, and probably SLE, can be modified by several strategies. These include improved access to good medical care, programs developed to educate people about SLE and associated conditions such as hypertension, increased opportunities for patients to continue normal activities, and programs that enhance patients' self-confidence and social support. (Consumer Summary produced by Reliance Medical Information, Inc.)