Surreal illustration of urban and rural landscapes merging, symbolizing the impact of living environment on immune health.

Urban vs. Rural: How Your Living Environment Impacts Lupus Risk and Symptoms

Theo Raines in Health & Wellness December 2025 • 4 min read.

"A groundbreaking study reveals the surprising ways urban and rural living environments affect the development and severity of systemic lupus erythematosus (SLE)."

Systemic lupus erythematosus (SLE), often just called lupus, is a long-term autoimmune disease where the body's immune system attacks its own tissues and organs. This can lead to inflammation, pain, and damage in various parts of the body. It’s a complex condition influenced by a mix of genetic, environmental, and lifestyle factors.

Researchers have long suspected that environmental factors play a significant role in the development and progression of lupus. While genetics certainly contribute, understanding how our surroundings impact the disease can open new doors for prevention and management. This brings us to an important question: Could where you live—whether in a bustling city or a quiet rural area—affect your risk and experience with lupus?

A recent study from Crete, Greece, has shed light on this very issue. By comparing individuals with lupus in urban versus rural settings, researchers uncovered intriguing differences in disease risk, symptom presentation, and overall severity. This article delves into the findings of this study, exploring how your living environment might be more influential than you think.

Key Findings: Unveiling the Urban vs. Rural Lupus Connection

Surreal illustration of urban and rural landscapes merging, symbolizing the impact of living environment on immune health.

The study, conducted on the island of Crete, included 399 participants with lupus. Researchers collected detailed information on their residential history, lifestyle, clinical data, and disease characteristics. By comparing those who lived exclusively in urban areas, exclusively in rural areas, or a mix of both, several key differences emerged.

Here’s a breakdown of the most significant findings:

Increased Risk in Urban Areas: The risk of developing lupus was approximately twice as high for individuals living in urban areas compared to those in rural areas.
Earlier Diagnosis in Urban Dwellers: People in urban areas were diagnosed with lupus nearly seven years earlier than their rural counterparts, even though diagnostic delays were similar in both groups.
Gender Differences: Urban areas had a lower female predominance in lupus cases (6.8:1 female-to-male ratio) compared to rural areas (15:1).
Socioeconomic Factors: Rural residents had fewer years of education and lower employment rates. Urban residents smoked more, while rural residents had greater exposure to pesticides.
Symptom Presentation: Certain symptoms like malar rash, photosensitivity, and oral ulcers were more common in rural patients.
Disease Severity: Moderate to severe disease was more frequently observed in rural-living patients.

These findings suggest that the living environment can indeed influence the risk, gender bias, and phenotype of lupus, potentially beyond what can be explained by socioeconomic factors alone.

What Does This Mean for You?

While the Crete study offers valuable insights, it's important to remember that this is just one piece of the puzzle. More research is needed to confirm these findings in other populations and to fully understand the underlying mechanisms. However, this study highlights the potential impact of our environment on autoimmune diseases like lupus. By recognizing these connections, we can move towards more targeted prevention and management strategies, ultimately improving the lives of those affected by this challenging condition.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1177/0961203318816820, Alternate LINK

Title: Is Systemic Lupus Erythematosus Different In Urban Versus Rural Living Environment? Data From The Cretan Lupus Epidemiology And Surveillance Registry

Subject: Rheumatology

Journal: Lupus

Publisher: SAGE Publications

Authors: I Gergianaki, A Fanouriakis, C Adamichou, G Spyrou, N Mihalopoulos, S Kazadzis, L Chatzi, P Sidiropoulos, D T Boumpas, G Bertsias

Published: 2018-12-06

Everything You Need To Know

What exactly is lupus?

Systemic lupus erythematosus (SLE), commonly known as lupus, is a chronic autoimmune condition where the body's immune system mistakenly attacks its own tissues and organs. This can result in inflammation, pain, and damage throughout the body. The causes are complex, involving genetic predisposition combined with environmental and lifestyle factors. It's significant because understanding these environmental influences, such as where someone lives, could help in preventing or managing the disease more effectively.

What were the main findings regarding urban versus rural living and lupus?

The study revealed that individuals living in urban areas had approximately twice the risk of developing lupus compared to those in rural settings. Furthermore, urban residents were diagnosed nearly seven years earlier than their rural counterparts. There were also differences in gender distribution among lupus cases, with a lower female predominance in urban areas compared to rural areas. This is important because it suggests that the living environment may have a more significant impact on the risk, gender bias, and characteristics of lupus than previously thought, even beyond socioeconomic factors.

Were there different symptoms of lupus depending on whether people lived in urban or rural areas?

The study identified several differences in symptom presentation between rural and urban lupus patients. Rural patients were more likely to exhibit symptoms such as malar rash, photosensitivity, and oral ulcers. Additionally, moderate to severe disease was more frequently observed in rural residents. These differences are significant because they indicate that the specific environment one lives in may influence how lupus manifests, potentially requiring tailored treatment and management approaches based on the patient's living environment.

Where was the study on urban and rural living conducted, and how many people were involved?

The study took place on the island of Crete, Greece, and involved 399 participants diagnosed with lupus. Researchers collected data on their residential history, lifestyle, clinical data, and disease characteristics, comparing individuals who lived exclusively in urban areas, exclusively in rural areas, or a mix of both. While the study provides important insights, it's crucial to note that further research is needed to validate these findings in different populations and to fully understand the underlying mechanisms behind these observations. This is significant as it represents an initial step towards understanding the environmental factors influencing lupus.

Did the study find any differences in socioeconomic factors between people with lupus living in urban versus rural environments?

The study identified several socioeconomic differences between urban and rural residents with lupus. Rural residents generally had fewer years of education and lower employment rates, while urban residents tended to smoke more. On the other hand, rural residents had greater exposure to pesticides. Socioeconomic factors and lifestyle differences highlight how various environmental exposures could affect lupus risk and severity. Further research is needed to explore how these factors individually and collectively contribute to the development and progression of lupus.