Lupus deaths remain high among Black patients despite overall decline since 1999
Key takeaways:
- Black patients, particularly women, had the highest age-adjusted SLE mortality rate of all races between 1999 and 2020.
- The highest mortality was concentrated in southern states.
Black patients, particularly women, have died from systemic lupus erythematosus at disproportionately higher rates despite overall declines in mortality over the past 20 years, according to data published in Arthritis Care & Research.
“SLE has historically been associated with high morbidity and mortality, with survival rates improving significantly from the 1950s to the early 2000s due to advances in diagnosis, disease management and immunosuppressive therapies,” Ansaam Daoud, MD, a rheumatologist at Case Western Reserve University, in Cleveland, told Healio. “However, despite these improvements, SLE mortality has remained disproportionately high compared to the general population, with evidence of persistent racial, ethnic and geographic disparities.
“The extent of progress in the last 2 decades — from 1999 to 2020 — remained unclear, and whether these disparities have improved or persisted remained uncertain,” she added.
To examine the associations between demographic characteristics and SLE mortality during that timeframe, Daoud and colleagues looked to the CDC’s Wide-ranging Online Data for Epidemiologic Research database, which contains information on nearly all deaths in the United States.
The researchers analyzed the database for death certificates with ICD-10 codes for “SLE,” “SLE with organ or system involvement,” “other forms of SLE” or “SLE, unspecified” listed as the underlying cause of death. They then used sex, race, ethnicity and state data to calculate age-adjusted mortality rates for each race and U.S. state.
From 1999 to 2020, the researchers identified 27,213 deaths in the United States with SLE as the underlying cause. According to the researchers, SLE deaths decreased across all demographic groups, with the overall age-adjusted mortality rate significantly declining (R2 = 0.902) over that time, based on a linear regression analysis.
The highest age-adjusted mortality rate was observed among Black patients, at 10.7 (95% CI, 10.48-10.92) deaths per million overall. Among Black women, the rate rose to 17.68 (95% CI, 17.29-18.06) deaths per million. The mortality rate was also elevated among American Indians/Alaska Natives, at 4.09 (95% CI, 3.59-4.59) deaths per million.
By contrast, Hispanic patients in 1999 demonstrated a higher age-adjusted mortality rate vs. non-Hispanic patients (6.22 vs. 4.46), but by 2020, that had reversed (3.03 vs. 3.34).
“This could be due to various factors, including increased public health awareness of more severe disease in this patient population, improved access to health care, better disease management and general health improvements in the Hispanic community,” Daoud said.
Meanwhile, white patients demonstrated a mortality rate of 2.85 (95% CI, 2.81-2.9) deaths per million, while Asian/Pacific Islanders showed 2.94 (95% CI, 2.76-3.12) deaths per million.
Mapping mortality rates onto U.S. states revealed that the highest rate was found in Louisiana (0.637 per 100,000), with higher rates also seen throughout the South, including in Mississippi, South Carolina, Arkansas, Oklahoma and New Mexico. However, there did not appear to be an association between high SLE mortality and poor rheumatology care, as assessed by the American College of Rheumatology 2022 Report Card, the researchers wrote.
For future studies, Daoud suggested focusing on the reasons behind these “complex and multifaceted disparities,” as well as evaluating whether the higher mortality rates in the south are driven by environmental or genetic factors.
“Our study highlights progress, but also ongoing challenges, in SLE mortality,” Daoud said. “Although overall trends are improving, equity remains a significant issue, particularly for African American women and patients in the south. By recognizing these gaps and working toward equity-driven interventions, we can continue making strides toward reducing SLE mortality for all patients.”
For more information:
Ansaam Daoud, MD, can be reached at ansaam.daoud@uhhospitals.org; X (Twitter): @DaoudAnsaam.
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