title: Lupus

text: SLE is associated with defects in apoptotic clearance, and the damaging effects caused by apoptotic debris. Early apoptotic cells express “eat-me” signals, of cell-surface proteins such as phosphatidylserine, that prompt immune cells to engulf them. Apoptotic cells also express find-me signals to attract macrophages and dendritic cells. When apoptotic material is not removed correctly by phagocytes, they are captured instead by antigen-presenting cells, which leads to the development of antinuclear antibodies.


title: Lupus

text: Monocytes isolated from whole blood of people with SLE show reduced expression of CD44 surface molecules involved in the uptake of apoptotic cells. Most of the monocytes and tingible body macrophages (TBMs), which are found in the germinal centres of lymph nodes, even show a definitely different morphology; they are smaller or scarce and die earlier. Serum components like complement factors, CRP, and some glycoproteins are, furthermore, decisively important for an efficiently operating phagocytosis. With SLE, these components are often missing, diminished, or inefficient.


title: Lupus

text: Macrophages during SLE fail to mature their lysosomes and as a result have impaired degradation of internalized apoptotic debris, which results in chronic activation of Toll-like receptors and permeabilization of the phagolysosomal membrane, allowing activation of cytosolic sensors. In addition, intact apoptotic debris recycles back to the cell membrane and accumulate on the surface of the cell.


title: Lupus

text: Recent research has found an association between certain people with lupus (especially those with lupus nephritis) and an impairment in degrading neutrophil extracellular traps (NETs). These were due to DNAse1 inhibiting factors, or NET protecting factors in people's serum, rather than abnormalities in the DNAse1 itself. DNAse1 mutations in lupus have so far only been found in some Japanese cohorts.


title: Lupus

text: The clearance of early apoptotic cells is an important function in multicellular organisms. It leads to a progression of the apoptosis process and finally to secondary necrosis of the cells if this ability is disturbed. Necrotic cells release nuclear fragments as potential autoantigens, as well as internal danger signals, inducing maturation of dendritic cells (DCs) since they have lost their membranes' integrity. Increased appearance of apoptotic cells also stimulates inefficient clearance. That leads to the maturation of DCs and also to the presentation of intracellular antigens of late apoptotic or secondary necrotic cells, via MHC molecules.


title: Lupus

text: Autoimmunity possibly results from the extended exposure to nuclear and intracellular autoantigens derived from late apoptotic and secondary necrotic cells. B and T cell tolerance for apoptotic cells is abrogated, and the lymphocytes get activated by these autoantigens; inflammation and the production of autoantibodies by plasma cells is initiated. A clearance deficiency in the skin for apoptotic cells has also been observed in people with cutaneous lupus erythematosus (CLE).


title: Lupus

text: In healthy conditions, apoptotic lymphocytes are removed in germinal centers (GC) by specialized phagocytes, the tingible body macrophages (TBM), which is why no free apoptotic and potential autoantigenic material can be seen. In some people with SLE, a buildup of apoptotic debris can be observed in GC because of an ineffective clearance of apoptotic cells. Close to TBM, follicular dendritic cells (FDC) are localised in GC, which attach antigen material to their surface and, in contrast to bone marrow-derived DC, neither take it up nor present it via MHC molecules.


title: Lupus

text: Autoreactive B cells can accidentally emerge during somatic hypermutation and migrate into the germinal center light zone. Autoreactive B cells, maturated coincidentally, normally do not receive survival signals by antigen planted on follicular dendritic cells and perish by apoptosis. In the case of clearance deficiency, apoptotic nuclear debris accumulates in the light zone of GC and gets attached to FDC.


title: Lupus

text: This serves as a germinal centre survival signal for autoreactive B-cells. After migration into the mantle zone, autoreactive B cells require further survival signals from autoreactive helper T cells, which promote the maturation of autoantibody-producing plasma cells and B memory cells. In the presence of autoreactive T cells, a chronic autoimmune disease may be the consequence.


title: Lupus

text: Anti-nRNP autoantibodies to nRNP A and nRNP C initially targeted restricted, proline-rich motifs. Antibody binding subsequently spread to other epitopes. The similarity and cross-reactivity between the initial targets of nRNP and Sm autoantibodies identifies a likely commonality in cause and a focal point for intermolecular epitope spreading.


title: Lupus

text: Elevated expression of HMGB1 was found in the sera of people and mice with systemic lupus erythematosus, high mobility group box 1 (HMGB1) is a nuclear protein participating in chromatin architecture and transcriptional regulation. Recently, there is increasing evidence HMGB1 contributes to the pathogenesis of chronic inflammatory and autoimmune diseases due to its inflammatory and immune stimulating properties.


title: Lupus

text: Antinuclear antibody (ANA) testing and anti-extractable nuclear antigen (anti-ENA) form the mainstay of serologic testing for SLE. If ANA is negative the disease can be ruled out.


title: Lupus

text: Several techniques are used to detect ANAs. The most widely used is indirect immunofluorescence (IF). The pattern of fluorescence suggests the type of antibody present in the people's serum. Direct immunofluorescence can detect deposits of immunoglobulins and complement proteins in people's skin. When skin not exposed to the sun is tested, a positive direct IF (the so-called lupus band test) is evidence of systemic lupus erythematosus.


title: Lupus

text: ANA screening yields positive results in many connective tissue disorders and other autoimmune diseases, and may occur in normal individuals. Subtypes of antinuclear antibodies include anti-Smith and anti-double stranded DNA (dsDNA) antibodies (which are linked to SLE) and anti-histone antibodies (which are linked to drug-induced lupus). Anti-dsDNA antibodies are highly specific for SLE; they are present in 70% of cases, whereas they appear in only 0.5% of people without SLE.


title: Lupus

text: Laboratory tests can also help distinguish between closely related connective tissue diseases. A multianalyte panel (MAP) of autoantibodies, including ANA, anti-dsDNA, and anti-Smith in combination with the measurement of cell-bound complement activation products (CB-CAPs) with an integrated algorithm has demonstrated 80% diagnostic sensitivity and 86% specificity in differentiating diagnosed SLE from other autoimmune connective tissue diseases. The MAP approach has been further studied in over 40,000 patients tested with either the MAP or traditional ANA testing strategy (tANA), demonstrating patients who test MAP positive are at up to 6-fold increased odds of receiving a new SLE diagnosis and up to 3-fold increased odds of starting a new SLE medication regimen as compared to patients testing positive with the tANA approach.


title: Lupus

text: The anti-dsDNA antibody titers also tend to reflect disease activity, although not in all cases. Other ANA that may occur in people with SLE are anti-U1 RNP (which also appears in systemic sclerosis and mixed connective tissue disease), SS-A (or anti-Ro) and SS-B (or anti-La; both of which are more common in Sjögren's syndrome). SS-A and SS-B confer a specific risk for heart conduction block in neonatal lupus.


title: Lupus

text: Other tests routinely performed in suspected SLE are complement system levels (low levels suggest consumption by the immune system), electrolytes and kidney function (disturbed if the kidney is involved), liver enzymes, and complete blood count.


title: Lupus

text: The lupus erythematosus (LE) cell test was commonly used for diagnosis, but it is no longer used because the LE cells are only found in 50–75% of SLE cases and they are also found in some people with rheumatoid arthritis, scleroderma, and drug sensitivities. Because of this, the LE cell test is now performed only rarely and is mostly of historical significance.


title: Lupus

text: Some physicians make a diagnosis based on the American College of Rheumatology (ACR) classification criteria. However, these criteria were primarily established for use in scientific research, including selection for randomized controlled trials, which require higher confidence levels. As a result, many people with SLE may not meet the full ACR criteria.


title: Lupus

text: The American College of Rheumatology (ACR) established eleven criteria in 1982, which were revised in 1997 as a classificatory instrument to operationalise the definition of SLE in clinical trials. They were not intended to be used to diagnose individuals and do not do well in that capacity. For the purpose of identifying people for clinical studies, a person has SLE if any 4 out of 11 symptoms are present simultaneously or serially on two separate occasions.


title: Lupus

text: Some people, especially those with antiphospholipid syndrome, may have SLE without four of the above criteria, and also SLE may present with features other than those listed in the criteria.


title: Lupus

text: Recursive partitioning has been used to identify more parsimonious criteria. This analysis presented two diagnostic classification trees:


title: Lupus

text: Other alternative criteria have been suggested, e.g. the St. Thomas' Hospital "alternative" criteria in 1998.


title: Lupus

text: The treatment of SLE involves preventing flares and reducing their severity and duration when they occur.


title: Lupus

text: Treatment can include corticosteroids and anti-malarial drugs. Certain types of lupus nephritis such as diffuse proliferative glomerulonephritis require intermittent cytotoxic drugs. These drugs include cyclophosphamide and mycophenolate. Cyclophosphamide increases the risk of developing infections, pancreas problems, high blood sugar, and high blood pressure.


title: Lupus

text: Hydroxychloroquine was approved by the FDA for lupus in 1955. Some drugs approved for other diseases are used for SLE 'off-label'. In November 2010, an FDA advisory panel recommended approving belimumab (Benlysta) as a treatment for the pain and flare-ups common in lupus. The drug was approved by the FDA in March 2011.


title: Lupus

text: In terms of healthcare utilization and costs, one study found that "patients from the US with SLE, especially individuals with moderate or severe disease, utilize significant healthcare resources and incur high medical costs."


title: Lupus

text: Due to the variety of symptoms and organ system involvement with SLE, its severity in an individual must be assessed to successfully treat SLE. Mild or remittent disease may, sometimes, be safely left untreated. If required, nonsteroidal anti-inflammatory drugs and antimalarials may be used. Medications such as prednisone, mycophenolic acid and tacrolimus have been used in the past.


title: Lupus

text: Disease-modifying antirheumatic drugs (DMARDs) are used preventively to reduce the incidence of flares, the progress of the disease, and the need for steroid use; when flares occur, they are treated with corticosteroids. DMARDs commonly in use are antimalarials such as hydroxychloroquine and immunosuppressants (e.g. methotrexate and azathioprine). Hydroxychloroquine is an FDA-approved antimalarial used for constitutional, cutaneous, and articular manifestations. Hydroxychloroquine has relatively few side effects, and there is evidence that it improves survival among people who have SLE.


title: Lupus

text: Cyclophosphamide is used for severe glomerulonephritis or other organ-damaging complications. Mycophenolic acid is also used for the treatment of lupus nephritis, but it is not FDA-approved for this indication, and FDA is investigating reports that it may be associated with birth defects when used by pregnant women.


title: Lupus

text: In more severe cases, medications that modulate the immune system (primarily corticosteroids and immunosuppressants) are used to control the disease and prevent recurrence of symptoms (known as flares). Depending on the dosage, people who require steroids may develop Cushing's syndrome, symptoms of which may include obesity, puffy round face, diabetes mellitus, increased appetite, difficulty sleeping, and osteoporosis. These may subside if and when the large initial dosage is reduced, but long-term use of even low doses can cause elevated blood pressure and cataracts.


title: Lupus

text: Numerous new immunosuppressive drugs are being actively tested for SLE. Rather than broadly suppressing the immune system, as corticosteroids do, they target the responses of specific types of immune cells. Some of these drugs are already FDA-approved for treatment of rheumatoid arthritis, however due to high-toxicity, their use remains limited.


title: Lupus

text: Since a large percentage of people with SLE have varying amounts of chronic pain, stronger prescription analgesics (painkillers) may be used if over-the-counter drugs (mainly nonsteroidal anti-inflammatory drugs) do not provide effective relief. Potent NSAIDs such as indomethacin and diclofenac are relatively contraindicated for people with SLE because they increase the risk of kidney failure and heart failure.


title: Lupus

text: Pain is typically treated with opioids, varying in potency based on the severity of symptoms. When opioids are used for prolonged periods, drug tolerance, chemical dependency, and addiction may occur. Opiate addiction is not typically a concern since the condition is not likely to ever completely disappear. Thus, lifelong treatment with opioids is fairly common for chronic pain symptoms, accompanied by periodic titration that is typical of any long-term opioid regimen.


title: Lupus

text: Intravenous immunoglobulins may be used to control SLE with organ involvement, or vasculitis. It is believed that they reduce antibody production or promote the clearance of immune complexes from the body, even though their mechanism of action is not well understood. Unlike immunosuppressives and corticosteroids, IVIGs do not suppress the immune system, so there is less risk of serious infections with these drugs.


title: Lupus

text: Avoiding sunlight in SLE is critical since sunlight is known to exacerbate skin manifestations of the disease. Avoiding activities that induce fatigue is also important since those with SLE fatigue easily and it can be debilitating. These two problems can lead to people becoming housebound for long periods of time. Drugs unrelated to SLE should be prescribed only when known not to exacerbate the disease. Occupational exposure to silica, pesticides, and mercury can also worsen the disease.


title: Lupus

text: Kidney transplants are the treatment of choice for end-stage kidney disease, which is one of the complications of lupus nephritis, but the recurrence of the full disease is common in up to 30% of people.


title: Lupus

text: Approximately 20% of people with SLE have clinically significant levels of antiphospholipid antibodies, which are associated with antiphospholipid syndrome. Antiphospholipid syndrome is also related to the onset of neural lupus symptoms in the brain. In this form of the disease, the cause is very different from lupus: thromboses (blood clots or "sticky blood") form in blood vessels, which prove to be fatal if they move within the bloodstream. If the thromboses migrate to the brain, they can potentially cause a stroke by blocking the blood supply to the brain.


title: Lupus

text: If this disorder is suspected in people, brain scans are usually required for early detection. These scans can show localized areas of the brain where blood supply has not been adequate. The treatment plan for these people requires anticoagulation. Often, low-dose aspirin is prescribed for this purpose, although for cases involving thrombosis anticoagulants such as warfarin are used.


title: Lupus

text: While most infants born to mothers who have SLE are healthy, pregnant mothers with SLE should remain under medical care until delivery. Neonatal lupus is rare, but identification of mothers at the highest risk for complications allows for prompt treatment before or after birth. In addition, SLE can flare up during pregnancy, and proper treatment can maintain the health of the mother longer. Women pregnant and known to have anti-Ro (SSA) or anti-La antibodies (SSB) often have echocardiograms during the 16th and 30th weeks of pregnancy to monitor the health of the heart and surrounding vasculature.


title: Lupus

text: Contraception and other reliable forms of pregnancy prevention are routinely advised for women with SLE since getting pregnant during active disease was found to be harmful. Lupus nephritis was the most common manifestation.


title: Lupus

text: In the 1950s, most people diagnosed with SLE lived fewer than five years. Today, over 90% now survive for more than ten years, and many live relatively symptom-free. 80–90% can expect to live a normal lifespan. Mortality rates are however elevated compared to people without SLE.


title: Lupus

text: Prognosis is typically worse for men and children than for women; however, if symptoms are present after age 60, the disease tends to run a more benign course. Early mortality, within 5 years, is due to organ failure or overwhelming infections, both of which can be altered by early diagnosis and treatment. The mortality risk is fivefold when compared to the normal population in the late stages, which can be attributed to cardiovascular disease from accelerated atherosclerosis, the leading cause of death for people with SLE. To reduce the potential for cardiovascular issues, high blood pressure and high cholesterol should be prevented or treated aggressively. Steroids should be used at the lowest dose for the shortest possible period, and other drugs that can reduce symptoms should be used whenever possible.


title: Lupus

text: The global rates of SLE are approximately 20–70 per 100,000 people. In females, the rate is highest between 45 and 64 years of age. The lowest overall rate exists in Iceland and Japan. The highest rates exist in the US and France. However, there is not sufficient evidence to conclude why SLE is less common in some countries compared to others; it could be the environmental variability in these countries. For example, different countries receive different levels of sunlight, and exposure to UV rays affects dermatological symptoms of SLE.


title: Lupus

text: Certain studies hypothesize that a genetic connection exists between race and lupus which affects disease prevalence. If this is true, the racial composition of countries affects disease and will cause the incidence in a country to change as the racial makeup changes. To understand if this is true, countries with largely homogenous and racially stable populations should be studied to better understand incidence. Rates of disease in the developing world are unclear.


title: Lupus

text: The rate of SLE varies between countries, ethnicity, and sex, and changes over time. In the United States, one estimate of the rate of SLE is 53 per 100,000; another estimate places the total affected population at 322,000 to over 1 million (98 to over 305 per 100,000). In Northern Europe the rate is about 40 per 100,000 people. SLE occurs more frequently and with greater severity among those of non-European descent. That rate has been found to be as high as 159 per 100,000 among those of Afro-Caribbean descent. Childhood-onset systemic lupus erythematosus generally presents between the ages of 3 and 15 and is four times more common in girls.


title: Lupus

text: While the onset and persistence of SLE can show disparities between genders, socioeconomic status also plays a major role. Women with SLE and of lower socioeconomic status have been shown to have higher depression scores, higher body mass index, and more restricted access to medical care than women of higher socioeconomic statuses with the illness. People with SLE had more self-reported anxiety and depression scores if they were from a lower socioeconomic status.


title: Lupus

text: There are assertions that race affects the rate of SLE. However, a 2010 review of studies that correlate race and SLE identified several sources of systematic and methodological error, indicating that the connection between race and SLE may be spurious. For example, studies show that social support is a modulating factor which buffers against SLE-related damage and maintains physiological functionality. Studies have not been conducted to determine whether people of different racial backgrounds receive differing levels of social support.


title: Lupus

text: If there is a difference, this could act as a confounding variable in studies correlating race and SLE. Another caveat to note when examining studies about SLE is that symptoms are often self-reported. This process introduces additional sources of methodological error. Studies have shown that self-reported data is affected by more than just the patient's experience with the disease- social support, the level of helplessness, and abnormal illness-related behaviors also factor into a self-assessment. Additionally, other factors like the degree of social support that a person receives, socioeconomic status, health insurance, and access to care can contribute to an individual's disease progression.


title: Lupus

text: Racial differences in lupus progression have not been found in studies that control for the socioeconomic status [SES] of participants. Studies that control for the SES of its participants have found that non-white people have more abrupt disease onset compared to white people and that their disease progresses more quickly. Non-white patients often report more hematological, serosal, neurological, and renal symptoms. However, the severity of symptoms and mortality are both similar in white and non-white patients. Studies that report different rates of disease progression in late-stage SLE are most likely reflecting differences in socioeconomic status and the corresponding access to care. The people who receive medical care have often accrued less disease-related damage and are less likely to be below the poverty line. Additional studies have found that education, marital status, occupation, and income create a social context that affects disease progression.


title: Lupus

text: SLE, like many autoimmune diseases, affects females more frequently than males, at a rate of about 9 to 1. The X chromosome carries immunological related genes, which can mutate and contribute to the onset of SLE. The Y chromosome has no identified mutations associated with autoimmune disease.


title: Lupus

text: Hormonal mechanisms could explain the increased incidence of SLE in females. The onset of SLE could be attributed to the elevated hydroxylation of estrogen and the abnormally decreased levels of androgens in females. In addition, differences in GnRH signalling have also been shown to contribute to the onset of SLE. While females are more likely to relapse than males, the intensity of these relapses is the same for both sexes.


title: Lupus

text: In addition to hormonal mechanisms, specific genetic influences found on the X chromosome may also contribute to the development of SLE. Studies indicate that the X chromosome can determine the levels of sex hormones. A study has shown an association between Klinefelter syndrome and SLE. XXY males with SLE have an abnormal X–Y translocation resulting in the partial triplication of the PAR1 gene region.


title: Lupus

text: The rate of SLE in the United States increased from 1.0 in 1955 to 7.6 in 1974. Whether the increase is due to better diagnosis or an increased frequency of the disease is unknown.


title: Lupus

text: The history of SLE can be divided into three periods: classical, neoclassical, and modern. In each period, research and documentation advanced the understanding and diagnosis of SLE, leading to its classification as an autoimmune disease in 1851, and to the various diagnostic options and treatments now available to people with SLE. The advances made by medical science in the diagnosis and treatment of SLE have dramatically improved the life expectancy of a person diagnosed with SLE.


title: Lupus

text: There are several explanations ventured for the term lupus erythematosus. Lupus is Latin for "wolf", and "erythro" is derived from , Greek for "red". All explanations originate with the reddish, butterfly-shaped malar rash that the disease classically exhibits across the nose and cheeks. The reason the term lupus was used to describe this disease comes from the mid-19th century. Many diseases that caused ulceration or necrosis were given the term "lupus" due to the wound being reminiscent of a wolf's bite. This is similar to the naming of lupus vulgaris or chronic facial tuberculosis, where the lesions are ragged and punched out and are said to resemble the bite of a wolf.


title: Lupus

text: The classical period began when the disease was first recognized in the Middle Ages. The term lupus is attributed to 12th-century Italian physician Rogerius Frugard, who used it to describe ulcerating sores on the legs of people. No formal treatment for the disease existed and the resources available to physicians to help people were limited.


title: Lupus

text: The neoclassical period began in 1851 when the skin disease which is now known as discoid lupus was documented by the French physician, Pierre Cazenave. Cazenave termed the illness lupus and added the word erythematosus to distinguish this disease from other illnesses that affected the skin except they were infectious. Cazenave observed the disease in several people and made very detailed notes to assist others in its diagnosis. He was one of the first to document that lupus affected adults from adolescence into the early thirties and that facial rash is its most distinguishing feature.


title: Lupus

text: Research and documentation of the disease continued in the neoclassical period with the work of Ferdinand von Hebra and his son-in-law, Moritz Kaposi. They documented the physical effects of lupus as well as some insights into the possibility that the disease caused internal trauma. Von Hebra observed that lupus symptoms could last many years and that the disease could go "dormant" after years of aggressive activity and then re-appear with symptoms following the same general pattern. These observations led Hebra to term lupus a chronic disease in 1872.


title: Lupus

text: Kaposi observed that lupus assumed two forms: the skin lesions (now known as discoid lupus) and a more aggravated form that affected not only the skin but also caused fever, arthritis, and other systemic disorders in people. The latter also presented a rash confined to the face, appearing on the cheeks and across the bridge of the nose; he called this the "butterfly rash". Kaposi also observed those patients who developed the butterfly rash were often afflicted with another disease such as tuberculosis, anemia, or chlorisis which often caused death. Kaposi was one of the first people to recognize what is now termed systemic lupus erythematosus in his documentation of the remitting and relapsing nature of the disease and the relationship of skin and systemic manifestations during disease activity.


title: Lupus

text: The 19th century's research into lupus continued with the work of Sir William Osler who, in 1895, published the first of his three papers about the internal complications of erythema exudativum multiforme. Not all the patient cases in his paper had SLE but Osler's work expanded the knowledge of systemic diseases and documented extensive and critical visceral complications for several diseases including lupus. Noting that many people with lupus had a disease that not only affected the skin but many other organs in the body as well, Osler added the word "systemic" to the term lupus erythematosus to distinguish this type of disease from discoid lupus erythematosus.


title: Lupus

text: Osler's second paper noted that reoccurrence is a special feature of the disease and that attacks can be sustained for months or even years. Further study of the disease led to a third paper, published in 1903, documenting afflictions such as arthritis, pneumonia, the inability to form coherent ideas, delirium, and central nervous system damage as all affecting patients diagnosed with SLE.


title: Lupus

text: The modern period, beginning in 1920, saw major developments in research into the cause and treatment of discoid and systemic lupus. Research conducted in the 1920s and 1930s led to the first detailed pathologic descriptions of lupus and demonstrated how the disease affected the kidney, heart, and lung tissue. A breakthrough was made in 1948 with the discovery of the LE cell (the lupus erythematosus cell—a misnomer, as it occurs with other diseases as well). Discovered by a team of researchers at the Mayo Clinic, they discovered that the white blood cells contained the nucleus of another cell that was pushing against the white's cell proper nucleus.


title: Lupus

text: Noting that the invading nucleus was coated with antibody that allowed it to be ingested by a phagocytic or scavenger cell, they named the antibody that causes one cell to ingest another the LE factor and the two nuclei cell result in the LE cell. The LE cell, it was determined, was a part of an anti-nuclear antibody (ANA) reaction; the body produces antibodies against its own tissue. This discovery led to one of the first definitive tests for lupus since LE cells are found in approximately 60% of all people diagnosed with lupus. The LE cell test is rarely performed as a definitive lupus test today as LE cells do not always occur in people with SLE and can occur in individuals with other autoimmune diseases. Their presence can help establish a diagnosis but no longer indicates a definitive SLE diagnosis.


title: Lupus

text: The discovery of the LE cell led to further research and this resulted in more definitive tests for lupus. Building on the knowledge that those with SLE had auto-antibodies that would attach themselves to the nuclei of normal cells, causing the immune system to send white blood cells to fight off these "invaders", a test was developed to look for the anti-nuclear antibody (ANA) rather than the LE cell specifically. This ANA test was easier to perform and led not only to a definitive diagnosis of lupus but also many other related diseases. This discovery led to the understanding of what is now known as autoimmune diseases.


title: Lupus

text: To ensure that the person has lupus and not another autoimmune disease, the American College of Rheumatology (ACR) established a list of clinical and immunologic criteria that, in any combination, point to SLE. The criteria include symptoms that the person can identify (e.g. pain) and things that a physician can detect in a physical examination and through laboratory test results. The list was originally compiled in 1971, initially revised in 1982, and further revised and improved in 2009.


title: Lupus

text: Medical historians have theorized that people with porphyria (a disease that shares many symptoms with SLE) generated folklore stories of vampires and werewolves, due to the photosensitivity, scarring, hair growth, and porphyrin brownish-red stained teeth in severe recessive forms of porphyria (or combinations of the disorder, known as dual, homozygous, or compound heterozygous porphyrias).


title: Lupus

text: Useful medication for the disease was first found in 1894 when quinine was first reported as an effective therapy. Four years later, the use of salicylates in conjunction with quinine was noted to be of still greater benefit. This was the best available treatment until the middle of the twentieth century when Hench discovered the efficacy of corticosteroids in the treatment of SLE.


title: Lupus

text: A study called BLISS-76 tested the drug belimumab, a fully human monoclonal anti-BAFF (or anti-BLyS) antibody. BAFF stimulates and extends the life of B lymphocytes, which produce antibodies against foreign and self-protein. It was approved by the FDA in March 2011. Genetically engineered immune cells are also being studied in animal models of the disease as of 2019.


title: Lupus

text: In September 2022, researchers at the University of Erlangen-Nuremberg published promising results using genetically altered immune cells to treat severely ill patients. Four women and one man received transfusions of CAR T cells modified to attack their B cells, eliminating the aberrant ones. The therapy drove the disease into remission in all five patients, who have been off lupus medication for several months after the treatment ended.


title: Mississippi

text: Mississippi () is a state in the Southeastern region of the United States, bordered to the north by Tennessee; to the east by Alabama; to the south by the Gulf of Mexico; to the southwest by Louisiana; and to the northwest by Arkansas. Mississippi's western boundary is largely defined by the Mississippi River. Mississippi is the 32nd largest and 35th-most populous of the 50 U.S. states and has the lowest per-capita income in the United States. Jackson is both the state's capital and largest city. Greater Jackson is the state's most populous metropolitan area, with a population of 591,978 in 2020.


title: Mississippi

text: On December 10, 1817, Mississippi became the 20th state admitted to the Union. By 1860, Mississippi was the nation's top cotton-producing state and slaves accounted for 55% of the state population. Mississippi declared its secession from the Union on January 9, 1861, and was one of the seven original Confederate States, which constituted the largest slaveholding states in the nation. Following the Civil War, it was restored to the Union on February 23, 1870.


title: Mississippi

text: Until the Great Migration of the 1930s, African Americans were a majority of Mississippi's population. In 2020, 37.6% of Mississippi's population was African American, the highest percentage of any state. Mississippi was the site of many prominent events during the civil rights movement, including the Ole Miss riot of 1962 by white students objecting to desegregation, the 1963 assassination of Medgar Evers, and the 1964 Freedom Summer murders of three activists working on voting rights.


title: Mississippi

text: Mississippi frequently ranks low among U.S. states in measures of health, education, and development, while ranking high in measures of poverty. Top economic industries in Mississippi today are agriculture and forestry. Mississippi produces more than half of the country's farm-raised catfish, and is also a top producer of sweet potatoes, cotton and pulpwood. Other main industries in Mississippi include advanced manufacturing, utilities, transportation, and health services.


title: Mississippi

text: Mississippi is almost entirely within the Gulf coastal plain, and generally consists of lowland plains and low hills. The northwest remainder of the state consists of the Mississippi Delta, a section of the Mississippi Alluvial Plain. Mississippi's highest point is Woodall Mountain at 807 feet (246 m) above sea level adjacent to the Cumberland Plateau; the lowest is the Gulf of Mexico. Mississippi has a humid subtropical climate classification.


title: Mississippi

text: The state's name is derived from the Mississippi River, which flows along and defines its western boundary. European-American settlers named it after the Ojibwe word ᒥᓯ-ᓰᐱ "misi-ziibi" ().


title: Mississippi

text: Near 10,000 BC Native Americans or Paleo-Indians arrived in what today is referred to as the American South. Paleo-Indians in the South were hunter-gatherers who pursued the megafauna that became extinct following the end of the Pleistocene age. In the Mississippi Delta, Native American settlements and agricultural fields were developed on the natural levees, higher ground in the proximity of rivers. The Native Americans developed extensive fields near their permanent villages. Together with other practices, they created some localized deforestation but did not alter the ecology of the Mississippi Delta as a whole.


title: Mississippi

text: After thousands of years, succeeding cultures of the Woodland and Mississippian culture eras developed rich and complex agricultural societies, in which surplus supported the development of specialized trades. Both were mound builder cultures. Those of the Mississippian culture were the largest and most complex, constructed beginning about 950 AD. The peoples had a trading network spanning the continent from the Great Lakes to the Gulf Coast. Their large earthworks, which expressed their cosmology of political and religious concepts, still stand throughout the Mississippi and Ohio River valleys.


title: Mississippi

text: Descendant Native American tribes of the Mississippian culture in the Southeast include the Chickasaw and Choctaw. Other tribes who inhabited the territory of Mississippi (and whose names were honored by colonists in local towns) include the Natchez, the Yazoo, and the Biloxi.


title: Mississippi

text: The first major European expedition into the territory that became Mississippi was that of the Spanish explorer, Hernando de Soto, who passed through the northeast part of the state in 1540, in his second expedition to the New World.


title: Mississippi

text: In April 1699, French colonists established the first European settlement at "Fort Maurepas" (also known as Old Biloxi), built in the vicinity of present-day Ocean Springs on the Gulf Coast. It was settled by Pierre Le Moyne d'Iberville. In 1716, the French founded Natchez on the Mississippi River (as "Fort Rosalie"); it became the dominant town and trading post of the area. The French called the greater territory "New France"; the Spanish continued to claim part of the Gulf coast area (east of Mobile Bay) of present-day southern Alabama, in addition to the entire area of present-day Florida. The British assumed control of the French territory after the French and Indian War.


title: Mississippi

text: During the colonial era, European settlers imported enslaved Africans to work on cash crop plantations. Under French and Spanish rule, there developed a class of free people of color ("gens de couleur libres"), mostly multiracial descendants of European men and enslaved or free black women, and their mixed-race children. In the early days the French and Spanish colonists were chiefly men. Even as more European women joined the settlements, the men had interracial unions among women of African descent (and increasingly, multiracial descent), both before and after marriages to European women. Often the European men would help their multiracial children get educated or gain apprenticeships for trades, and sometimes they settled property on them; they often freed the mothers and their children if enslaved, as part of contracts of "plaçage". With this social capital, the free people of color became artisans, and sometimes educated merchants and property owners, forming a third class between the Europeans and most enslaved Africans in the French and Spanish settlements, although not so large a free community as in the city of New Orleans, Louisiana.


title: Mississippi

text: After Great Britain's victory in the French and Indian War (Seven Years' War), the French surrendered the Mississippi area to them under the terms of the Treaty of Paris (1763). They also ceded their areas to the north that were east of the Mississippi River, including the Illinois Country and Quebec. After the Peace of Paris (1783), the lower third of Mississippi came under Spanish rule as part of West Florida. In 1819 the United States completed the purchase of West Florida and all of East Florida in the Adams–Onís Treaty, and in 1822 both were merged into the Florida Territory.


title: Mississippi

text: After the American Revolution (1775–83), Britain ceded this area to the new United States of America. The Mississippi Territory was organized on April 7, 1798, from territory ceded by Georgia and South Carolina to the United States. Their original colonial charters theoretically extended west to the Pacific Ocean. The Mississippi Territory was later twice expanded to include disputed territory claimed by both the United States and Spain.


title: Mississippi

text: From 1800 to about 1830, the United States purchased some lands (Treaty of Doak's Stand) from Native American tribes for new settlements of European Americans. The latter were mostly migrants from other Southern states, particularly Virginia and North Carolina, where soils were exhausted. New settlers kept encroaching on Choctaw land, and they pressed the federal government to expel the Native Americans. On September 27, 1830, the Treaty of Dancing Rabbit Creek was signed between the U.S. Government and the Choctaw. The Choctaw agreed to sell their traditional homelands in Mississippi and Alabama, for compensation and removal to reservations in Indian Territory (now Oklahoma). This opened up land for sale to European-American migrant settlement.


title: Mississippi

text: Article 14 in the treaty allowed those Choctaw who chose to remain in the states to become U.S. citizens, as they were considered to be giving up their tribal membership. They were the second major Native American ethnic group to do so (some Cherokee were the first, who chose to stay in North Carolina and other areas during rather than join the removal). Today their descendants include approximately 9,500 persons identifying as Choctaw, who live in Neshoba, Newton, Leake, and Jones counties. The Mississippi Band of Choctaw Indians reorganized in the 20th century and is a Federally recognized tribe.


title: Mississippi

text: Many slaveholders brought enslaved African Americans with them or purchased them through the domestic slave trade, especially in New Orleans. Through the trade, an estimated nearly one million slaves were forcibly transported to the Deep South, including Mississippi, in an internal migration that broke up many slave families of the Upper South, where planters were selling excess slaves. The Southerners imposed slave laws in the Deep South and restricted the rights of free blacks.


title: Mississippi

text: Beginning in 1822, slaves in Mississippi were protected by law from cruel and unusual punishment by their owners. The Southern slave codes made the willful killing of a slave illegal in most cases. For example, the 1860 Mississippi case of "Oliver v. State" charged the defendant with murdering his own slave.


title: Mississippi

text: Mississippi became the 20th state on December 10, 1817. David Holmes was the first governor. The state was still occupied as ancestral land by several Native American tribes, including Choctaw, Natchez, Houma, Creek, and Chickasaw.


title: Mississippi

text: Plantations were developed primarily along the major rivers, where the waterfront provided access to the major transportation routes. This is also where early towns developed, linked by the steamboats that carried commercial products and crops to markets. The remainder of Native American ancestral land remained largely undeveloped but was sold through treaties until 1826, when the Choctaws and Chickasaws refused to sell more land. The combination of the Mississippi state legislature's abolition of Choctaw Tribal Government in 1829, President Andrew Jackson's Indian Removal Act and the Treaty of Dancing Rabbit Creek of 1830, the Choctaw were effectively forced to sell their land and were transported to Oklahoma Territory. The forced migration of the Choctaw, together with other southeastern tribes removed as a result of the Act, became known as the Trail of Tears.


title: Mississippi

text: When cotton was king during the 1850s, Mississippi plantation owners—especially those of the Delta and Black Belt central regions—became wealthy due to the high fertility of the soil, the high price of cotton on the international market, and free labor gained through their holding enslaved African Americans. They used some of their profits to buy more cotton land and more slaves. The planters' dependence on hundreds of thousands of slaves for labor and the severe wealth imbalances among whites, played strong roles both in state politics and in planters' support for secession. Mississippi was a slave society, with the economy dependent on slavery. The state was thinly settled, with population concentrated in the riverfront areas and towns.


title: Mississippi

text: By 1860, the enslaved African-American population numbered 436,631 or 55% of the state's total of 791,305 persons. Fewer than 1000 were free people of color. The relatively low population of the state before the American Civil War reflected the fact that land and villages were developed only along the riverfronts, which formed the main transportation corridors. Ninety percent of the Delta bottomlands were still frontier and undeveloped. The state needed many more settlers for development. The land further away from the rivers was cleared by freedmen and white migrants during Reconstruction and later.


title: Mississippi

text: On January 9, 1861, Mississippi became the second state to declare its secession from the Union, and it was one of the founding members of the Confederate States. The first six states to secede were those with the highest number of slaves. During the war, Union and Confederate forces struggled for dominance on the Mississippi River, critical to supply routes and commerce. More than 80,000 Mississippians fought in the Civil War for the Confederate Army. Around 17,000 black and 545 white Mississippians would serve in the Union Army. Pockets of Unionism in Mississippi were in places such as the northeastern corner of the state and Jones County, where Newton Knight, formed a revolt with Unionist leanings, known as the "Free State of Jones." Union General Ulysses S. Grant's long siege of Vicksburg finally gained the Union control of the river in 1863.


title: Mississippi

text: In the postwar period, freedmen withdrew from white-run churches to set up independent congregations. The majority of blacks left the Southern Baptist Convention, sharply reducing its membership. They created independent black Baptist congregations. By 1895 they had established numerous black Baptist state associations and the National Baptist Convention of black churches.


title: Mississippi

text: In addition, independent black denominations, such as the African Methodist Episcopal Church (established in Philadelphia, Pennsylvania in the early 19th century) and the African Methodist Episcopal Zion Church (established in New York City), sent missionaries to the South in the postwar years. They quickly attracted hundreds of thousands of converts and founded new churches across the South. Southern congregations brought their own influences to those denominations as well.


title: Mississippi

text: During Reconstruction, the first Mississippi constitutional convention in 1868, with delegates both black and white, framed a constitution whose major elements would be maintained for 22 years. The convention was the first political organization in the state to include African-American representatives, 17 among the 100 members (32 counties had black majorities at the time). Some among the black delegates were freedmen, but others were educated free blacks who had migrated from the North. The convention adopted universal suffrage; did away with property qualifications for suffrage or for office, a change that also benefited both blacks and poor whites; provided for the state's first public school system; forbade race distinctions in the possession and inheritance of property; and prohibited limiting civil rights in travel. Under the terms of Reconstruction, Mississippi was restored to the Union on February 23, 1870.


title: Mississippi

text: Because the Mississippi Delta contained so much fertile bottomland that had not been developed before the American Civil War, 90 percent of the land was still frontier. After the Civil War, tens of thousands of migrants were attracted to the area by higher wages offered by planters trying to develop land. In addition, black and white workers could earn money by clearing the land and selling timber, and eventually advance to ownership. The new farmers included many freedmen, who by the late 19th century achieved unusually high rates of land ownership in the Mississippi bottomlands. In the 1870s and 1880s, many black farmers succeeded in gaining land ownership.


title: Mississippi

text: Around the start of the 20th century, two-thirds of the Mississippi farmers who owned land in the Delta were African American. But many had become overextended with debt during the falling cotton prices of the difficult years of the late 19th century. Cotton prices fell throughout the decades following the Civil War. As another agricultural depression lowered cotton prices into the 1890s, numerous African-American farmers finally had to sell their land to pay off debts, thus losing the land which they had developed by hard, personal labor.


title: Mississippi

text: Democrats had regained control of the state legislature in 1875, after a year of expanded violence against blacks and intimidation of whites in what was called the "white line" campaign, based on asserting white supremacy. Democratic whites were well armed and formed paramilitary organizations such as the Red Shirts to suppress black voting. From 1874 to the elections of 1875, they pressured whites to join the Democrats, and conducted violence against blacks in at least 15 known "riots" in cities around the state to intimidate blacks. They killed a total of 150 blacks, although other estimates place the death toll at twice as many. A total of three white Republicans and five white Democrats were reported killed. In rural areas, deaths of blacks could be covered up. Riots (better described as massacres of blacks) took place in Vicksburg, Clinton, Macon, and in their counties, as well-armed whites broke up black meetings and lynched known black leaders, destroying local political organizations. Seeing the success of this deliberate "Mississippi Plan", South Carolina and other states followed it and also achieved white Democratic dominance. In 1877 by a national compromise, the last of federal troops were withdrawn from the region.


title: Mississippi

text: Even in this environment, black Mississippians continued to be elected to local office. However, black residents were deprived of all political power after white legislators passed a new state constitution in 1890 specifically to "eliminate the nigger from politics", according to the state's Democratic governor, James K. Vardaman. It erected barriers to voter registration and instituted electoral provisions that effectively disenfranchised most black Mississippians and many poor whites. Estimates are that 100,000 black and 50,000 white men were removed from voter registration rolls in the state over the next few years.


title: Mississippi

text: The loss of political influence contributed to the difficulties of African Americans in their attempts to obtain extended credit in the late 19th century. Together with imposition of Jim Crow and racial segregation laws, whites increased violence against blacks, lynching mostly men, through the period of the 1890s and extending to 1930. Cotton crops failed due to boll weevil infestation and successive severe flooding in 1912 and 1913, creating crisis conditions for many African Americans. With control of the ballot box and more access to credit, white planters bought out such farmers, expanding their ownership of Delta bottomlands. They also took advantage of new railroads sponsored by the state.


title: Mississippi

text: In 1900, blacks made up more than half of the state's population. By 1910, a majority of black farmers in the Delta had lost their land and become sharecroppers. By 1920, the third generation after freedom, most African Americans in Mississippi were landless laborers again facing poverty. Starting about 1913, tens of thousands of black Americans left Mississippi for the North in the Great Migration to industrial cities such as St. Louis, Chicago, Detroit, Cleveland, Philadelphia and New York. They sought jobs, better education for their children, the right to vote, relative freedom from discrimination, and better living. In the migration of 1910–1940, they left a society that had been steadily closing off opportunity. Most migrants from Mississippi took trains directly north to Chicago and often settled near former neighbors.


title: Mississippi

text: Blacks also faced violence in the form of lynching, shooting, and the burning of churches. In 1923, the National Association for the Advancement of Colored People stated "the Negro feels that life is not safe in Mississippi and his life may be taken with impunity at any time upon the slightest pretext or provocation by a white man".


title: Mississippi

text: In the early 20th century, some industries were established in Mississippi, but jobs were generally restricted to whites, including child workers. The lack of jobs also drove some southern whites north to cities such as Chicago and Detroit, seeking employment, where they also competed with European immigrants. The state depended on agriculture, but mechanization put many farm laborers out of work.


title: Mississippi

text: By 1900, many white ministers, especially in the towns, subscribed to the Social Gospel movement, which attempted to apply Christian ethics to social and economic needs of the day. Many strongly supported Prohibition, believing it would help alleviate and prevent many sins. Mississippi became a dry state in 1908 by an act of the state legislature. It remained dry until the legislature passed a local option bill in 1966.


title: Mississippi

text: African-American Baptist churches grew to include more than twice the number of members as their white Baptist counterparts. The African-American call for social equality resonated throughout the Great Depression in the 1930s and World War II in the 1940s.


title: Mississippi

text: The Second Great Migration from the South started in the 1940s, lasting until 1970. Almost half a million people left Mississippi in the second migration, three-quarters of them black. Nationwide during the first half of the 20th century, African Americans became rapidly urbanized and many worked in industrial jobs. The Second Great Migration included destinations in the West, especially California, where the buildup of the defense industry offered higher-paying jobs to both African Americans and whites.


title: Mississippi

text: Blacks and whites in Mississippi generated rich, quintessentially American music traditions: gospel music, country music, jazz, blues and rock and roll. All were invented, promulgated or heavily developed by Mississippi musicians, many of them African American, and most came from the Mississippi Delta. Many musicians carried their music north to Chicago, where they made it the heart of that city's jazz and blues.


title: Mississippi

text: So many African Americans left in the Great Migration that after the 1930s, they became a minority in Mississippi. In 1960 they made up 42% of the state's population. The whites maintained their discriminatory voter registration processes established in 1890, preventing most blacks from voting, even if they were well educated. Court challenges were not successful until later in the century. After World War II, African-American veterans returned with renewed commitment to be treated as full citizens of the United States and increasingly organized to gain enforcement of their constitutional rights.


title: Mississippi

text: The Civil Rights movement had many roots in religion, and the strong community of churches helped supply volunteers and moral purpose for their activism. Mississippi was a center of activity, based in black churches, to educate and register black voters, and to work for integration. In 1954 the state had created the Mississippi State Sovereignty Commission, a tax-supported agency, chaired by the Governor, that claimed to work for the state's image but effectively spied on activists and passed information to the local White Citizens' Councils to suppress black activism. White Citizens Councils had been formed in many cities and towns to resist integration of schools following the unanimous 1954 United States Supreme Court ruling ("Brown v. Board of Education") that segregation of public schools was unconstitutional. They used intimidation and economic blackmail against activists and suspected activists, including teachers and other professionals. Techniques included loss of jobs and eviction from rental housing.


title: Mississippi

text: In the summer of 1964 students and community organizers from across the country came to help register black voters in Mississippi and establish Freedom Schools. The Mississippi Freedom Democratic Party was established to challenge the all-white Democratic Party of the Solid South. Most white politicians resisted such changes. Chapters of the Ku Klux Klan and its sympathizers used violence against activists, most notably the murders of Chaney, Goodman, and Schwerner in 1964 during the Freedom Summer campaign. This was a catalyst for Congressional passage the following year of the Voting Rights Act of 1965. Mississippi earned a reputation in the 1960s as a reactionary state.


title: Mississippi

text: After decades of disenfranchisement, African Americans in the state gradually began to exercise their right to vote again for the first time since the 19th century, following the passage of federal civil rights legislation in 1964 and 1965, which ended "de jure" segregation and enforced constitutional voting rights. Registration of African-American voters increased and black candidates ran in the 1967 elections for state and local offices. The Mississippi Freedom Democratic Party fielded some candidates. Teacher Robert G. Clark of Holmes County was the first African American to be elected to the State House since Reconstruction. He continued as the only African American in the state legislature until 1976 and was repeatedly elected into the 21st century, including three terms as Speaker of the House.


title: Mississippi

text: In 1966, the state was the last to repeal officially statewide prohibition of alcohol. Before that, Mississippi had taxed the illegal alcohol brought in by bootleggers. Governor Paul Johnson urged repeal and the sheriff "raided the annual Junior League Mardi Gras ball at the Jackson Country Club, breaking open the liquor cabinet and carting off the Champagne before a startled crowd of nobility and high-ranking state officials".


title: Mississippi

text: On August 17, 1969, Category 5 Hurricane Camille hit the Mississippi coast, killing 248 people and causing US$1.5 billion in damage (1969 dollars).


title: Mississippi

text: Mississippi ratified the Nineteenth Amendment to the United States Constitution, in March 1984, which had already entered into force by August 1920; granting women the right to vote.


title: Mississippi

text: In 1987, 20 years after the U.S. Supreme Court had ruled in 1967's "Loving v. Virginia" that a similar Virginian law was unconstitutional, Mississippi repealed its ban on interracial marriage (also known as miscegenation), which had been enacted in 1890. It also repealed the segregationist-era poll tax in 1989. In 1995, the state symbolically ratified the Thirteenth Amendment, which had abolished slavery in 1865. Though ratified in 1995, the state never officially notified the Federal Archivist, which kept the ratification unofficial until 2013, when Ken Sullivan contacted the office of Secretary of State of Mississippi, Delbert Hosemann, who agreed to file the paperwork and make it official. In 2009, the legislature passed a bill to repeal other discriminatory civil rights laws, which had been enacted in 1964, the same year as the federal Civil Rights Act, but ruled unconstitutional in 1967 by federal courts. Republican Governor Haley Barbour signed the bill into law.


title: Mississippi

text: The end of legal segregation and Jim Crow led to the integration of some churches, but most today remain divided along racial and cultural lines, having developed different traditions. After the Civil War, most African Americans left white churches to establish their own independent congregations, particularly Baptist churches, establishing state associations and a national association by the end of the century. They wanted to express their own traditions of worship and practice. In more diverse communities, such as Hattiesburg, some churches have multiracial congregations.


title: Mississippi

text: On August 29, 2005, Hurricane Katrina, though a Category 3 storm upon final landfall, caused even greater destruction across the entire of the Mississippi Gulf Coast from Louisiana to Alabama.


title: Mississippi

text: The previous flag of Mississippi, used until June 30, 2020, featured the Confederate battle flag. Mississippi became the last state to remove the Confederate battle flag as an official state symbol on June 30, 2020, when Governor Tate Reeves signed a law officially retiring the second state flag. The current flag, The "New Magnolia" flag, was selected via referendum as part of the general election on November 3, 2020. It officially became the state flag on January 11, 2021, after being signed into law by the state legislature and governor.


title: Mississippi

text: Mississippi is bordered to the north by Tennessee, to the east by Alabama, to the south by Louisiana and a narrow coast on the Gulf of Mexico; and to the west, across the Mississippi River, by Louisiana and Arkansas.


title: Mississippi

text: In addition to its namesake, major rivers in Mississippi include the Big Black River, the Pearl River, the Yazoo River, the Pascagoula River, and the Tombigbee River. Major lakes include Ross Barnett Reservoir, Arkabutla, Sardis, and Grenada, with the largest being Sardis Lake.


title: Mississippi

text: Mississippi is entirely composed of lowlands, the highest point being Woodall Mountain, at above sea level, in the northeastern part of the state. The lowest point is sea level at the Gulf Coast. The state's mean elevation is above sea level.


title: Mississippi

text: Most of Mississippi is part of the East Gulf Coastal Plain. The coastal plain is generally composed of low hills, such as the Pine Hills in the south and the North Central Hills. The Pontotoc Ridge and the Fall Line Hills in the northeast have somewhat higher elevations. Yellow-brown loess soil is found in the western parts of the state. The northeast is a region of fertile black earth uplands, a geology that extend into the Alabama Black Belt.


title: Mississippi

text: The coastline includes large bays at Bay St. Louis, Biloxi, and Pascagoula. It is separated from the Gulf of Mexico proper by the shallow Mississippi Sound, which is partially sheltered by Petit Bois Island, Horn Island, East and West Ship Islands, Deer Island, Round Island, and Cat Island.


title: Mississippi

text: The northwest remainder of the state consists of the Mississippi Delta, a section of the Mississippi Alluvial Plain. The plain is narrow in the south and widens north of Vicksburg. The region has rich soil, partly made up of silt which had been regularly deposited by the flood waters of the Mississippi River.


title: Mississippi

text: Mississippi City Population Rankings of at least 20,000 but fewer than 50,000 (United States Census Bureau as of 2017):


title: Mississippi

text: Mississippi City Population Rankings of at least 10,000 but fewer than 20,000 (United States Census Bureau as of 2017):


title: Mississippi

text: "(See: Lists of cities, towns and villages, census-designated places, metropolitan areas, micropolitan areas, and counties in Mississippi)"


title: Mississippi

text: Mississippi has a humid subtropical climate with long, hot and humid summers, and short, mild winters. Temperatures average about in July and about in January. The temperature varies little statewide in the summer; however, in winter, the region near Mississippi Sound is significantly warmer than the inland portion of the state. The recorded temperature in Mississippi has ranged from , in 1966, at Corinth in the northeast, to , in 1930, at Holly Springs in the north. Heavy snowfall rarely occurs, but isn't unheard of, such as during the New Year's Eve 1963 snowstorm. Yearly precipitation generally increases from north to south, with the regions closer to the Gulf being the most humid. Thus, Clarksdale, in the northwest, gets about of precipitation annually and Biloxi, in the south, about . Small amounts of snow fall in northern and central Mississippi; snow is occasional in the southern part of the state.


title: Mississippi

text: The late summer and fall is the seasonal period of risk for hurricanes moving inland from the Gulf of Mexico, especially in the southern part of the state. Hurricane Camille in 1969 and Hurricane Katrina in 2005, which killed 238 people in the state, were the most devastating hurricanes to hit the state. Both caused nearly total storm surge destruction of structures in and around Gulfport, Biloxi, and Pascagoula.


title: Mississippi

text: As in the rest of the Deep South, thunderstorms are common in Mississippi, especially in the southern part of the state. On average, Mississippi has around 27 tornadoes annually; the northern part of the state has more tornadoes earlier in the year and the southern part a higher frequency later in the year. Two of the five deadliest tornadoes in United States history have occurred in the state. These storms struck Natchez, in southwest Mississippi (see The Great Natchez Tornado) and Tupelo, in the northeast corner of the state. About seven F5 tornadoes have been recorded in the state.


title: Mississippi

text: Mississippi is heavily forested, with over half of the state's area covered by wild or cultivated trees. The southeastern part of the state is dominated by longleaf pine, in both uplands and lowland flatwoods and Sarracenia bogs. The Mississippi Alluvial Plain, or Delta, is primarily farmland and aquaculture ponds but also has sizeable tracts of cottonwood, willows, bald cypress, and oaks. A belt of loess extends north to south in the western part of the state, where the Mississippi Alluvial Plain reaches the first hills; this region is characterized by rich, mesic mixed hardwood forests, with some species disjunct from Appalachian forests. Two bands of historical prairie, the Jackson Prairie and the Black Belt, run northwest to southeast in the middle and northeastern part of the state. Although these areas have been highly degraded by conversion to agriculture, a few areas remain, consisting of grassland with interspersed woodland of eastern redcedar, oaks, hickories, osage-orange, and sugarberry. The rest of the state, primarily north of Interstate 20 not including the prairie regions, consists of mixed pine-hardwood forest, common species being loblolly pine, oaks (e.g., water oak), hickories, sweetgum, and elm. Areas along large rivers are commonly inhabited by bald cypress, water tupelo, water elm, and bitter pecan. Commonly cultivated trees include loblolly pine, longleaf pine, cherrybark oak, and cottonwood.


title: Mississippi

text: There are approximately 3000 species of vascular plants known from Mississippi. As of 2018, a project funded by the U.S. National Science Foundation aims to update that checklist of plants with museum (herbarium) vouchers and create an online atlas of each species's distribution.


title: Mississippi

text: Mississippi also has a rich freshwater mussel fauna, with about 90 species in the primary family of native mussels (Unionidae). Several of these species were extirpated during the construction of the Tennessee-Tombigbee Waterway.


title: Mississippi

text: Due to seasonal flooding, possible from December to June, the Mississippi and Yazoo rivers and their tributaries created a fertile floodplain in the Mississippi Delta. The river's flooding created natural levees, which planters had built higher to try to prevent flooding of land cultivated for cotton crops. Temporary workers built levees along the Mississippi River on top of the natural levees that formed from dirt deposited after the river flooded.


title: Mississippi

text: From 1858 to 1861, the state took over levee building, accomplishing it through contractors and hired labor. In those years, planters considered their slaves too valuable to hire out for such dangerous work. Contractors hired gangs of Irish immigrant laborers to build levees and sometimes clear land. Many of the Irish were relatively recent immigrants from the famine years who were struggling to get established. Before the American Civil War, the earthwork levees averaged six feet in height, although in some areas they reached twenty feet.


title: Mississippi

text: Flooding has been an integral part of Mississippi history, but clearing of the land for cultivation and to supply wood fuel for steamboats took away the absorption of trees and undergrowth. The banks of the river were denuded, becoming unstable and changing the character of the river. After the Civil War, major floods swept down the valley in 1865, 1867, 1874 and 1882. Such floods regularly overwhelmed levees damaged by Confederate and Union fighting during the war, as well as those constructed after the war. In 1877, the state created the Mississippi Levee District for southern counties.


title: Mississippi

text: In 1879, the United States Congress created the Mississippi River Commission, whose responsibilities included aiding state levee boards in the construction of levees. Both white and black transient workers were hired to build the levees in the late 19th century. By 1882, levees averaged seven feet in height, but many in the southern Delta were severely tested by the flood that year. After the 1882 flood, the levee system was expanded. In 1884, the Yazoo-Mississippi Delta Levee District was established to oversee levee construction and maintenance in the northern Delta counties; also included were some counties in Arkansas which were part of the Delta.


title: Mississippi

text: Flooding overwhelmed northwestern Mississippi in 1912–1913, causing heavy damage to the levee districts. Regional losses and the Mississippi River Levee Association's lobbying for a flood control bill helped gain passage of national bills in 1917 and 1923 to provide federal matching funds for local levee districts, on a scale of 2:1. Although U.S. participation in World War I interrupted funding of levees, the second round of funding helped raise the average height of levees in the Mississippi-Yazoo Delta to in the 1920s. Scientists now understand the levees have increased the severity of flooding by increasing the flow speed of the river and reducing the area of the floodplains. The region was severely damaged due to the Great Mississippi Flood of 1927, which broke through the levees. There were losses of millions of dollars in property, stock and crops. The most damage occurred in the lower Delta, including Washington and Bolivar counties.


title: Mississippi

text: Even as scientific knowledge about the Mississippi River has grown, upstream development and the consequences of the levees have caused more severe flooding in some years. Scientists now understand that the widespread clearing of land and building of the levees have changed the nature of the river. Such work removed the natural protection and absorption of wetlands and forest cover, strengthening the river's current. The state and federal governments have been struggling for the best approaches to restore some natural habitats in order to best interact with the original riverine ecology.


title: Mississippi

text: Mississippi's population has remained from 2 million people at the 1930 U.S. census, to 2.9 million at the 2020 census. In contrast with Alabama to its east, and Louisiana to its west, Mississippi has been the slowest growing of the three Gulf coast states by population. According to the U.S. Census Bureau, Mississippi's center of population is located in Leake County, in the town of Lena.


title: Mississippi

text: From 2000 to 2010, the United States Census Bureau reported that Mississippi had the highest rate of increase in people identifying as mixed-race, up 70 percent in the decade; it amounts to a total of 1.1 percent of the population. In addition, Mississippi led the nation for most of the last decade in the growth of mixed marriages among its population. The total population has not increased significantly, but is young. Some of the above change in identification as mixed-race is due to new births. But, it appears mostly to reflect those residents who have chosen to identify as more than one race, who in earlier years may have identified by just one race and/or ethnicity. A binary racial system had been in place since slavery times and the days of official government racial segregation. In the civil rights era, people of African descent banded together in an inclusive community to achieve political power and gain restoration of their civil rights.


title: Mississippi

text: As the demographer William H. Frey noted, "In Mississippi, I think it's [identifying as mixed race] changed from within." Historically in Mississippi, after Indian removal in the 1830s, the major groups were designated as black (African American), who were then mostly enslaved, and white (primarily European American). Matthew Snipp, also a demographer, commented on the increase in the 21st century in the number of people identifying as being of more than one race: "In a sense, they're rendering a more accurate portrait of their racial heritage that in the past would have been suppressed."


title: Mississippi

text: After having accounted for a majority of the state's population since well before the American Civil War and through the 1930s, today African Americans constitute approximately 37.8 percent of the state's population. Most have ancestors who were enslaved, with many forcibly transported from the Upper South in the 19th century to work on the area's new plantations. Many of these slaves were mixed race, with European ancestors, as there were many children born into slavery with white fathers. Some also have Native American ancestry. During the first half of the 20th century, a total of nearly 400,000 African Americans left the state during the Great Migration, for opportunities in the North, Midwest and West. They became a minority in the state for the first time since early in its development.


title: Mississippi

text: Americans of Scots-Irish, English and Scottish ancestry are present throughout the state. It is believed that there are more people with such ancestry than identify as such on the census, in part because their immigrant ancestors are more distant in their family histories. English, Scottish and Scots-Irish are generally the most under-reported ancestry groups in both the South Atlantic states and the East South Central states. The historian David Hackett Fischer estimated that a minimum 20% of Mississippi's population is of English ancestry, though the figure is probably much higher, and another large percentage is of Scottish ancestry. Many Mississippians of such ancestry identify simply as American on questionnaires, because their families have been in North America for centuries. In the 1980 U.S. census, 656,371 Mississippians of a total of 1,946,775 identified as being of English ancestry, making them 38% of the state at the time.


title: Mississippi

text: The state in 2010 had the highest proportion of African Americans in the nation. The African American percentage of population has begun to increase due mainly to a younger population than the whites (the total fertility rates of the two races are approximately equal). Due to patterns of settlement and whites putting their children in private schools, in almost all of Mississippi's public school districts, a majority of students are African American. African Americans are the majority ethnic group in the northwestern Yazoo Delta, and the southwestern and the central parts of the state. These are areas where, historically, African Americans owned land as farmers in the 19th century following the Civil War, or worked on cotton plantations and farms.


title: Mississippi

text: People of French Creole ancestry form the largest demographic group in Hancock County on the Gulf Coast. The African American, Choctaw (mostly in Neshoba County), and Chinese American portions of the population are also almost entirely native born.


title: Mississippi

text: The Chinese first came to Mississippi as contract workers from Cuba and California in the 1870s, and they originally worked as laborers on the cotton plantations. However, most Chinese families came later between 1910 and 1930 from other states, and most operated small family-owned groceries stores in the many small towns of the Delta. In these roles, the ethnic Chinese carved out a niche in the state between black and white, where they were concentrated in the Delta. These small towns have declined since the late 20th century, and many ethnic Chinese have joined the exodus to larger cities, including Jackson. Their population in the state overall has increased in the 21st century.


title: Mississippi

text: In the early 1980s many Vietnamese immigrated to Mississippi and other states along the Gulf of Mexico, where they became employed in fishing-related work.


title: Mississippi

text: As of 2011, 53.8% of Mississippi's population younger than age 1 were minorities, meaning that they had at least one parent who was not non-Hispanic white.


title: Mississippi

text: "Note: Births in table don't add up, because Hispanics are counted both by their ethnicity and by their race, giving a higher overall number."


title: Mississippi

text: The 2010 United States census counted 6,286 same-sex unmarried-partner households in Mississippi, an increase of 1,512 since the 2000 United States census. Of those same-sex couples roughly 33% contained at least one child, giving Mississippi the distinction of leading the nation in the percentage of same-sex couples raising children. Mississippi has the largest percentage of African American same-sex couples among total households. The state capital, Jackson, ranks tenth in the nation in concentration of African American same-sex couples. The state ranks fifth in the nation in the percentage of Hispanic same-sex couples among all Hispanic households and ninth in the highest concentration of same-sex couples who are seniors.


title: Mississippi

text: In 2000, 96.4% of Mississippi residents five years old and older spoke only English in the home, a decrease from 97.2% in 1990. English is largely Southern American English, with some South Midland speech in northern and eastern Mississippi. There is a common absence of final /r/, particularly in the elderly natives and African Americans, and the lengthening and weakening of the diphthongs /aɪ/ and /ɔɪ/ as in 'ride' and 'oil'. South Midland terms in northern Mississippi include: tow sack (burlap bag), dog irons (andirons), plum peach (clingstone peach), snake doctor (dragonfly), and stone wall (rock fence).


title: Mississippi

text: Under French and Spanish rule beginning in the 17th century, European colonists were mostly Roman Catholics. The growth of the cotton culture after 1815 brought in tens of thousands of Anglo-American settlers each year, most of whom were Protestants from Southeastern states. Due to such migration, there was rapid growth in the number of Protestant denominations and churches, especially among the Methodists, Presbyterians and Baptists.


title: Mississippi

text: The revivals of the Great Awakening in the late 18th and early 19th centuries initially attracted the "plain folk" by reaching out to all members of society, including women and blacks. Both slaves and free blacks were welcomed into Methodist and Baptist churches. Independent black Baptist churches were established before 1800 in Virginia, Kentucky, South Carolina and Georgia, and later developed in Mississippi as well.


title: Mississippi

text: In the post-Civil War years, religion became more influential as the South became known as the "Bible Belt". By 2014, the Pew Research Center determined 83% of its population was Christian. In a separate study by the Public Religion Research Institute in 2020, 80% of the population was Christian.


title: Mississippi

text: Since the 1970s, fundamentalist conservative churches have grown rapidly, fueling Mississippi's conservative political trends among whites. In 1973 the Presbyterian Church in America attracted numerous conservative congregations. As of 2010, Mississippi remained a stronghold of the denomination, which originally was brought by Scots immigrants. The state has the highest adherence rate of the PCA in 2010, with 121 congregations and 18,500 members. It is among the few states where the PCA has higher membership than the PC(USA).


title: Mississippi

text: According to the Association of Religion Data Archives (ARDA), in 2010 the Southern Baptist Convention had 907,384 adherents and was the largest religious denomination in the state, followed by the United Methodist Church with 204,165, and the Roman Catholic Church with 112,488. Other religions have a small presence in Mississippi; as of 2010, there were 5,012 Muslims; 4,389 Hindus; and 816 of the Baháʼí Faith.


title: Mississippi

text: According to the Pew Research Center in 2014, with evangelical Protestantism as the predominant Christian affiliation, the Southern Baptist Convention remained the largest denomination in the state. Non-denominational Evangelicals were the second-largest, followed by historically African American denominations such as the National Baptist Convention, USA and Progressive National Baptist Convention.


title: Mississippi

text: Public opinion polls have consistently ranked Mississippi as the most religious state in the United States, with 59% of Mississippians considering themselves "very religious". The same survey also found that 11% of the population were non-Religious. In a 2009 Gallup poll, 63% of Mississippians said that they attended church weekly or almost weekly—the highest percentage of all states (U.S. average was 42%, and the lowest percentage was in Vermont at 23%). Another 2008 Gallup poll found that 85% of Mississippians considered religion an important part of their daily lives, the highest figure among all states (U.S. average 65%).


title: Mississippi

text: The state is ranked 50th or last place among all the states for health care, according to the Commonwealth Fund, a nonprofit foundation working to advance performance of the health care system.


title: Mississippi

text: Mississippi has the highest rate of infant and neonatal deaths of any U.S. state. Age-adjusted data also shows Mississippi has the highest overall death rate, and the highest death rate from heart disease, hypertension and hypertensive renal disease, influenza and pneumonia.


title: Mississippi

text: For three years in a row, more than 30 percent of Mississippi's residents have been classified as obese. In a 2006 study, 22.8 percent of the state's children were classified as such. Mississippi had the highest rate of obesity of any U.S. state from 2005 to 2008, and also ranks first in the nation for high blood pressure, diabetes, and adult inactivity. In a 2008 study of African-American women, contributing risk factors were shown to be: lack of knowledge about body mass index (BMI), dietary behavior, physical inactivity and lack of social support, defined as motivation and encouragement by friends. A 2002 report on African-American adolescents noted a 1999 survey which suggests that a third of children were obese, with higher ratios for those in the Delta.


title: Mississippi

text: The study stressed that "obesity starts in early childhood extending into the adolescent years and then possibly into adulthood". It noted impediments to needed behavioral modification, including the Delta likely being "the most underserved region in the state" with African Americans the major ethnic group; lack of accessibility and availability of medical care; and an estimated 60% of residents living below the poverty level. Additional risk factors were that most schools had no physical education curriculum and nutrition education is not emphasized. Previous intervention strategies may have been largely ineffective due to not being culturally sensitive or practical. A 2006 survey found nearly 95 percent of Mississippi adults considered childhood obesity to be a serious problem.


title: Mississippi

text: A 2017 study found that Blue Cross and Blue Shield of Mississippi was the leading health insurer with 53% followed by UnitedHealth Group at 13%.


title: Mississippi

text: The Bureau of Economic Analysis estimates that Mississippi's total state product in 2010 was $98 billion. GDP growth was .5 percent in 2015 and is estimated to be 2.4 in 2016 according to Dr. Darrin Webb, the state's chief economist, who noted it would make two consecutive years of positive growth since the recession. Per capita personal income in 2006 was $26,908, the lowest per capita personal income of any state, but the state also has the nation's lowest living costs. 2015 data records the adjusted per capita personal income at $40,105. Mississippians consistently rank as one of the highest per capita in charitable contributions.


title: Mississippi

text: At 56 percent, the state has one of the lowest workforce participation rates in the country. Approximately 70,000 adults are disabled, which is 10 percent of the workforce.


title: Mississippi

text: Mississippi's rank as one of the poorest states is related to its dependence on cotton agriculture before and after the Civil War, late development of its frontier bottomlands in the Mississippi Delta, repeated natural disasters of flooding in the late 19th and early 20th century that required massive capital investment in levees, and ditching and draining the bottomlands, and slow development of railroads to link bottomland towns and river cities. In addition, when Democrats regained control of the state legislature, they passed the 1890 constitution that discouraged corporate industrial development in favor of rural agriculture, a legacy that would slow the state's progress for years.


title: Mississippi

text: Before the Civil War, Mississippi was the fifth-wealthiest state in the nation, its wealth generated by the labor of slaves in cotton plantations along the rivers.


title: Mississippi

text: Slaves were counted as property and the rise in the cotton markets since the 1840s had increased their value. By 1860, a majority—55 percent—of the population of Mississippi was enslaved. Ninety percent of the Delta bottomlands were undeveloped and the state had low overall density of population.


title: Mississippi

text: Largely due to the domination of the plantation economy, focused on the production of agricultural cotton, the state's elite was reluctant to invest in infrastructure such as roads and railroads. They educated their children privately. Industrialization did not reach many areas until the late 20th century. The planter aristocracy, the elite of antebellum Mississippi, kept the tax structure low for their own benefit, making only private improvements. Before the war the most successful planters, such as Confederate President Jefferson Davis, owned riverside properties along the Mississippi and Yazoo rivers in the Mississippi Delta. Away from the riverfronts, most of the Delta was undeveloped frontier.


title: Mississippi

text: During the Civil War, 30,000 Mississippi soldiers, mostly white, died from wounds and disease, and many more were left crippled and wounded. Changes to the labor structure and an agricultural depression throughout the South caused severe losses in wealth. In 1860 assessed valuation of property in Mississippi had been more than $500 million, of which $218 million (43 percent) was estimated as the value of slaves. By 1870, total assets had decreased in value to roughly $177 million.


title: Mississippi

text: Poor whites and landless former slaves suffered the most from the postwar economic depression. The constitutional convention of early 1868 appointed a committee to recommend what was needed for relief of the state and its citizens. The committee found severe destitution among the laboring classes. It took years for the state to rebuild levees damaged in battles. The upset of the commodity system impoverished the state after the war. By 1868 an increased cotton crop began to show possibilities for free labor in the state, but the crop of 565,000 bales produced in 1870 was still less than half of prewar figures.


title: Mississippi

text: Blacks cleared land, selling timber and developing bottomland to achieve ownership. In 1900, two-thirds of farm owners in Mississippi were blacks, a major achievement for them and their families. Due to the poor economy, low cotton prices and difficulty of getting credit, many of these farmers could not make it through the extended financial difficulties. Two decades later, the majority of African Americans were sharecroppers. The low prices of cotton into the 1890s meant that more than a generation of African Americans lost the result of their labor when they had to sell their farms to pay off accumulated debts.


title: Mississippi

text: After the Civil War, the state refused for years to build human capital by fully educating all its citizens. In addition, the reliance on agriculture grew increasingly costly as the state suffered loss of cotton crops due to the devastation of the boll weevil in the early 20th century, devastating floods in 1912–1913 and 1927, collapse of cotton prices after 1920, and drought in 1930.


title: Mississippi

text: It was not until 1884, after the flood of 1882, that the state created the Mississippi-Yazoo Delta District Levee Board and started successfully achieving longer-term plans for levees in the upper Delta. Despite the state's building and reinforcing levees for years, the Great Mississippi Flood of 1927 broke through and caused massive flooding of throughout the Delta, homelessness for hundreds of thousands, and millions of dollars in property damages. With the Depression coming so soon after the flood, the state suffered badly during those years. In the Great Migration, hundreds of thousands of African Americans migrated North and West for jobs and chances to live as full citizens.


title: Mississippi

text: The legislature's 1990 decision to legalize casino gambling along the Mississippi River and the Gulf Coast has led to increased revenues and economic gains for the state. Gambling towns in Mississippi have attracted increased tourism: they include the Gulf Coast resort towns of Bay St. Louis, Gulfport and Biloxi, and the Mississippi River towns of Tunica (the third largest gaming area in the United States), Greenville, Vicksburg and Natchez.


title: Mississippi

text: Before Hurricane Katrina struck the Gulf Coast, Mississippi was the second-largest gambling state in the Union, after Nevada and ahead of New Jersey. An estimated $500,000 per day in tax revenue was lost following Hurricane Katrina's severe damage to several coastal casinos in Biloxi in August 2005. Because of the destruction from this hurricane, on October 17, 2005, Governor Haley Barbour signed a bill into law that allows casinos in Hancock and Harrison counties to rebuild on land (but within of the water). The only exception is in Harrison County, where the new law states that casinos can be built to the southern boundary of U.S. Route 90.


title: Mississippi

text: In 2012, Mississippi had the sixth largest gambling revenue of any state, with $2.25 billion. The federally recognized Mississippi Band of Choctaw Indians has established a gaming casino on its reservation, which yields revenue to support education and economic development.


title: Mississippi

text: Momentum Mississippi, a statewide, public–private partnership dedicated to the development of economic and employment opportunities in Mississippi, was adopted in 2005.


title: Mississippi

text: Mississippi, like the rest of its southern neighbors, is a right-to-work state. It has some major automotive factories, such as the Toyota Mississippi Plant in Blue Springs and a Nissan Automotive plant in Canton. The latter produces the Nissan Titan.


title: Mississippi

text: Mississippi collects personal income tax in three tax brackets, ranging from 3% to 5%. The retail sales tax rate in Mississippi is 7%. Tupelo levies a local sales tax of 2.5%. State sales tax growth was 1.4 percent in 2016 and estimated to be slightly less in 2017. For purposes of assessment for ad valorem taxes, taxable property is divided into five classes.


title: Mississippi

text: On August 30, 2007, a report by the United States Census Bureau indicated that Mississippi was the poorest state in the country. Major cotton farmers in the Delta have large, mechanized plantations, and they receive the majority of extensive federal subsidies going to the state, yet many other residents still live as poor, rural, landless laborers. The state's sizable poultry industry has faced similar challenges in its transition from family-run farms to large mechanized operations. Of $1.2 billion from 2002 to 2005 in federal subsidies to farmers in the Bolivar County area of the Delta, only 5% went to small farmers. There has been little money apportioned for rural development. Small towns are struggling. More than 100,000 people have left the region in search of work elsewhere. The state had a median household income of $34,473.


title: Mississippi

text: As of December 2018, the state's unemployment rate was 4.7%, the seventh highest in the country after Arizona (4.9%), Louisiana (4.9%), New Mexico (5.0%), West Virginia (5.1%), District of Columbia (5.4%) and Alaska (6.5%).


title: Mississippi

text: With Mississippi's fiscal conservatism, in which Medicaid, welfare, food stamps, and other social programs are often cut, eligibility requirements are tightened, and stricter employment criteria are imposed, Mississippi ranks as having the second-highest ratio of spending to tax receipts of any state. In 2005, Mississippi citizens received approximately $2.02 per dollar of taxes in the way of federal spending. This ranks the state second-highest nationally, and represents an increase from 1995, when Mississippi received $1.54 per dollar of taxes in federal spending and was 3rd highest nationally. This figure is based on federal spending after large portions of the state were devastated by Hurricane Katrina, requiring large amounts of federal aid from the Federal Emergency Management Agency (FEMA). However, from 1981 to 2005, it was at least number four in the nation for federal spending vs. taxes received.


title: Mississippi

text: A proportion of federal spending in Mississippi is directed toward large federal installations such as Camp Shelby, John C. Stennis Space Center, Meridian Naval Air Station, Columbus Air Force Base, and Keesler Air Force Base. Three of these installations are located in the area affected by Hurricane Katrina.


title: Mississippi

text: As with all other U.S. states and the federal government, Mississippi's government is based on the separation of legislative, executive and judicial power. Executive authority in the state rests with the Governor, currently Tate Reeves (R). The lieutenant governor, currently Delbert Hosemann (R), is elected on a separate ballot. Both the governor and lieutenant governor are elected to four-year terms of office. Unlike the federal government, but like many other U.S. states, most of the heads of major executive departments are elected by the citizens of Mississippi rather than appointed by the governor.


title: Mississippi

text: Mississippi is one of five states that elects its state officials in odd-numbered years (the others are Kentucky, Louisiana, New Jersey and Virginia). Mississippi holds elections for these offices every four years, always in the year preceding presidential elections.


title: Mississippi

text: In 2004, Mississippi voters approved a state constitutional amendment banning same-sex marriage and prohibiting Mississippi from recognizing same-sex marriages performed elsewhere. The amendment passed 86% to 14%, the largest margin in any state. Same-sex marriage became legal in Mississippi on June 26, 2015, when the United States Supreme Court invalidated all state-level bans on same-sex marriage as unconstitutional in the landmark case "Obergefell v. Hodges".


title: Mississippi

text: With the passing of HB 1523 in April 2016, from July it became legal in Mississippi to refuse service to same-sex couples, based on one's religious beliefs. The bill has become the subject of controversy. A federal judge blocked the law in July of that year; however, it was challenged, and a federal appeals court ruled in favor of the law in October 2017.


title: Mississippi

text: Mississippi is one of the most anti-abortion states in the United States. A 2014 poll by Pew Research Center found that 59% of the state's population thinks abortion should be illegal in all/most cases, while only 36% of the state's population thinks abortion should be legal in all/most cases.


title: Mississippi

text: Mississippi has banned sanctuary cities. Mississippi is one of thirty-one states which practice capital punishment (see also: capital punishment in Mississippi).


title: Mississippi

text: Section 265 of the Constitution of the State of Mississippi declares that "No person who denies the existence of a Supreme Being shall hold any office in this state." However, this religious test restriction was held to be unconstitutional by the U.S. Supreme Court in "Torcaso v. Watkins" (1961).


title: Mississippi

text: Gun laws in Mississippi are among the most permissive in the country, with no license or background check required to openly carry handguns in most places in the state.


title: Mississippi

text: In 2021, the U.S. Supreme Court ruled in a 6−3 decision in "Jones v. Mississippi" that a Mississippi law allowing mandatory sentencing of children to life imprisonment without parole is valid and that states and judges can impose such sentences without separately deciding if the child can be rehabilitated.