Higher Lupus Mortality Among Minority Populations Save

The February 19th MMWR reports that higher mortality rates in certain patients with systemic lupus erythematosus (SLE); data based on recent San Francisco County statistics showing a four fold higher mortality among Asian and Hispanic/Latina females with SLE.

SLE severity varies and may put patients at higher risk for severe outcomes.  Prior studies have attempted to look at the morbid and mortal risks.

Among 812 patients in the California Lupus Surveillance Project (CLSP) during 2007–2009, who were matched to the 2007–2017 National Death Index (NDI), 16.6% had died by 2017. This included persons of White (14.4%), Black (25%), Asian (15.3%), and Hispanic/Latino (15.5%) race/ethnicity. Standardized mortality ratios (SMRs) of observed-to-expected deaths among persons with SLE within each racial/ethnic group were 2.3, 2.0, 3.8, and 3.9, respectively. These findings were amongst the first to to show higher mortality among Asian and Hispanic/Latino persons with SLE.

Among the 812 SLE patients analyzed, 731 (90%) were female; and there were 135 (16.6%) total deaths were identified.

Mean age at diagnosis among all SLE patients was 34.9 years (range = 19.0–50.8 years), and mean age at death was 62.0 years (range = 46.2–77.8 years).

Mortality increased with age. The highest percentage of deaths (25%) occurred among Black SLE patients. On average, Black persons died 6.8 years earlier than did White persons (p = 0.05); persons of Hispanic/Latino ethnicity died 9.5 years earlier than did persons who were not of Hispanic/Latino ethnicity (p = 0.02).

Overall, SMRs were three times higher among SLE patients than among those in the general population of San Francisco County. Compared with SMRs among their non-SLE counterparts, SMRs among patients with SLE were four times higher in females and among persons of Asian and Hispanic/Latino race/ethnicity, three times higher among males, and two times higher among White and Black persons. Among females, SMRs were especially high among Asian (4.1) and Hispanic/Latina patients.

Mortality among persons with SLE is high among all racial and ethnic groups but is especially pronounced in Asian and Hispanic/Latino populations. There is a need for research and greater understanding of racial, ethnic, and socioeconomic disparities among persons with SLE, and to develop SLE-specific interventions, such as coordination of robust care models between primary care providers and rheumatologists to ensure that persons with SLE receive a timely diagnosis and appropriate treatments that might help address SLE-associated mortality.