Age-specific Incidence of Systemic Lupus Erythematosus Save

Epidemiologic estimates on systemic lupus erythematosus (SLE) diagnosis are limited. The Centers for Disease Control and Prevention (CDC) National Lupus Registry network of population-based SLE registries has assessed and reported age-specific incidence of SLE by sex, race, and ethnicity.

The CDC network of SLE registries includes five state-based registries (Georgia (GLR), Michigan (MILES), California (CLSP), Manhattan (MLSP), and newly added Minnesota/Wisconsin (LUMEN) registries), plus a sixth Indian Health Service registry. Incidence periods spanned calendar years 2002-2018. Age-specific incidence was reported per 100,000 person-years, stratified by sex, race, and ethnicity for the meta-analyses.

Pooling six CDC-funded population-based lupus registries (1,281 incident cases, 2002–2018), Izmirly et al. show that SLE age-at-diagnosis spans the full life course far more than commonly assumed — 10.0% of cases present before age 20 and 15.1% present at or after age 60 yrs,

Peak incidence in men occurs at 60–69 years, not in young adulthood, and Black women aged 20–39 have the highest incidence of any subgroup (23.6/100,000 person-years).

Black women aged 20-39 had the highest SLE incidence rates (23.6, 95%CI: 20.7-26.8) per 100,000 PYs

Among women diagnosed with SLE before age 20, incidence was highest among Asian (6.5, 95%CI: 2.8-15.2) individuals. Among women diagnosed with SLE after age 60, incidence was highest among American Indian/Alaska Native (9.4, 95%CI: 3.4-15.4) individuals. 

Overall SLE incidence: 5.2/100,000 person-years (95%CI 4.0–6.6); 8.7 in women vs. 1.4 in men.

Note: Pediatric SLE, while less common, is not negligible (10% of cases), with Asian and Black girls/women at highest early-onset risk.  Also, these findings likely underestimate true incidence, given known 10–15% case-ascertainment misses in capture-recapture validation of these registries.