Despite improving trends in lupus-related mortality, rates appear to remain high relative to non-lupus causes

1. Over the 46-year study period, systemic lupus erythematosus (SLE) age-standardized mortality rates (ASMRs) did not decline as much as non-SLE ASMR, and there was a 34.6% cumulative growth in the ratio of SLE to non-SLE ASMR.

2. SLE ASMRs were higher in the elderly, females, black and Hispanic individuals, and residents of the West (non-white individuals) and the South (white individuals).

Evidence Rating Level: 4 (Below Average)      

Study Rundown: There are limited options for treating SLE, a chronic autoimmune disease.  Although mortality trends for SLE have improved over time, the effect on mortality of recent developments for SLE diagnosis and treatment in the United States are not known.  This population-based study used nationwide mortality and census data to analyze trends and demographic differences associated with mortality from SLE in the United States from 1968 to 2013.  Researchers found that although SLE mortality rates have declined since 1968, they remain high compared to non-SLE mortality.  Researchers also found that there were significant differences in sex, race, and geography for SLE mortality.  The authors suggest that gathering prospective population-based data may aid in understanding the factors involved in the differences for SLE mortality.  This data could help detect risk factors that could possibly be modified, which may assist in public health efforts to decrease health disparities.

Strengths of the study include computing the ratio of SLE and non-SLE ASMR compared to all-cause mortality as well as the use of multivariate regression analyses to evaluate the effect of regional and demographic characteristics on SLE mortality.  Limitations include difficulty in determining coding accuracy on death certificates and possible underestimation of SLE ASMRs due to underreporting of SLE on death certificates.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Mortality in systemic lupus erythematosus: an updated review

In-Depth [nationwide population-based study]: In this study, researchers used the Centers for Disease Control and Prevention’s (CDC’s) Wide-ranging Online Data for Epidemiologic Research database to collect data on SLE mortality from 1968 (when the CDC started publishing mortality data on the county level) through 2013.  The authors used joinpoint regression to fit broken-line trends to the annual SLE and non-SLE ASMR as well as the ratio of SLE to non-SLE ASMR over the studied time period.  The authors analyzed SLE and non-SLE mortality causes by sex, race or ethnicity, and geography.  From 1968 to 2013, there were 50 249 and 100 851 288 deaths due to SLE and non-SLE causes, respectively.  Over the study period, SLE ASMR did not decline as much as non-SLE ASMR, and there was a 34.6% cumulative growth in the ratio of SLE to non-SLE ASMR.  Although non-SLE ASMR declined every year, SLE ASMR declined between 1968 and 1975 but rose between 1975 and 1999.  SLE ASMR then declined again after 1999.  SLE ASMRs were higher in the elderly, females, black and Hispanic individuals, and residents of the West (non-white individuals) and the South (white individuals).

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