Background/Purpose: Over the past half-century, diagnostic and therapeutic developments for SLE have led to dramatic improvements in the 5- and 10-year survival. Whether these achievements have improved the long-term trends in mortality in SLE is unclear.

Methods: We measured temporal trends in age-standardized mortality rates (ASMR) for SLE and non-SLE causes by joinpoint trend analysis using county-level data abstracted from the Centers for Disease Control and Prevention database. We calculated the annual % change in mortality over the past 46 years. Logistic regression was applied to model the association of sex, race and geographic region on SLE deaths. We calculated SLE case-fatality by dividing the SLE-mortality by the estimated SLE prevalence within each demographic variable. Since no national SLE prevalence is available, we estimated these values with weighted visit data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

Results: SLE was listed as the primary cause of death in 50,249 individuals from 1968-2013 in the US. The crude mortality rate for SLE peaked during the 1970s-80s and declined during 2000s. Black race was associated with the highest SLE crude mortality rate in each period. While ASMR for non-SLE causes continuously declined throughout the 46 years, the SLE ASMR showed periods of sustained increase from mid-1970s-1990s followed by a decline in 2000s. The higher SLE mortality in the general population was associated with female sex, Black race, and residence in the West or South. The national estimates for SLE prevalence per 100,000 were 221.17 in females, 20.08 (males), 170.5 (Blacks), 107.44 (Whites) and 133.5 (Hispanics), and ranged from and 106.36 (Midwest) to 138.35 (Northeast). Using these national prevalence estimates, we calculated case-fatality. Analysis of the trend in SLE case-fatality showed an overall decline in rates from 1999-2013. The average annual % change in SLE case-fatality ranged from -2.5% per year to -3.1% per year in various subpopulations during 1999-2013. Analyses of case-fatality in different subpopulations revealed that in the SLE subpopulation, males had a higher mortality (odds ratio 1.94, p<0.001), and even after adjusting for the prevalence variability, the SLE mortality remained higher in Blacks (odds ratio 5.24, p<0.001), and in people living in the South (odds ratio 1.55, p<0.001) and the West (odds ratio 1.44, p<0.001) than in the Northeast. Age of death histograms showed that Blacks died from SLE at a younger age than Whites with 50% of total deaths occurring by age 45 years in Blacks versus age 59 years in Whites. Likewise, Hispanics died younger with half of the SLE deaths occurring by age 44 years versus non-Hispanics by age 54 years.

Conclusion: Mortality from non-SLE causes declined throughout the 46 years, however, SLE mortality rates had periods of increases and more recent declines. SLE deaths occur younger in Blacks and Hispanics, and SLE case-fatality is greater in males. Despite encouraging trends in overall SLE mortality, significant gender, racial, ethnic and regional disparities persist. The findings provide impetus to delineate the next steps to improve these disparities.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/temporal-trends-in-sle-mortality-according-to-sex-race-ethnicity-and-geographic-region-in-the-united-states-over-the-past-five-decades/