Racial Disparities in Mortality Associated with Systemic Lupus Erythematosus - Fulton and DeKalb Counties, Georgia, 2002-2016

Abstract

Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease with often nonspecific symptoms that can lead to a delay in diagnosis. The disease disproportionately affects women and minorities. Blacks with SLE also have more severe disease and develop it at an earlier age (1). Despite an increase in the 5-year survival rate from 50% in 1955 to approximately 90% in the 2000s, attributed largely to advances in management of SLE (2), premature mortality among SLE patients persists, often as a result of disease severity, infections, and cardiovascular disease. Because existing SLE mortality estimates based on death certificate data are known to underestimate SLE deaths (3), SLE mortality was analyzed using 2002-2004 data from the population-based Georgia Lupus Registry (1). Incident and prevalent SLE cases matched to the National Death Index through 2016 identified 97 and 401 deaths, respectively. Standardized mortality ratios adjusted for age group, sex, and race were two to three times higher among persons with SLE relative to expected deaths in the general population. Blacks had significantly higher cumulative mortality than did whites, and blacks with both incident and prevalent cases were significantly younger at death (mean age 51.8 and 52.3 years, respectively) than were whites (mean age 64.4 and 65.0 years, respectively). Whites had lower mortality after diagnosis than did blacks; among incident cases, mortality among whites did not occur until 5 years after SLE diagnosis, whereas blacks had significantly and persistently higher mortality from the time of diagnosis. There were no significant differences by sex. Current CDC-supported efforts encourage early detection, diagnosis, and treatment, and enhanced self-management skills to mitigate racial disparities and improve outcomes overall among persons with SLE.

FIGURE 1

Cumulative mortality of incident systemic lupus erythematosus (SLE) cases diagnosed during 2002–2004, by black/white race — Georgia Lupus Registry, 2002–2016 * Cumulative mortality for incident SLE cases was calculated using Kaplan-Meier survival analysis to indicate the probability of SLE patients dying at a specified time since diagnosis. Difference p = 0.008, by log rank test.

FIGURE 2

Cumulative mortality of prevalent systemic lupus erythematosus (SLE) cases diagnosed in 2002, by black/white race — Georgia Lupus Registry, 2002–2016 * Cumulative mortality for prevalent SLE cases was calculated using Kaplan-Meier survival analysis to indicate the probability of SLE patients dying at a specified time since 2002. Difference p = 0.025, by log rank test.