Background/Purpose: Patients with systemic lupus erythematosus (SLE) have a 3-fold increase in all-cause mortality, compared to the general population. Young patients with SLE are 40 and 60 times more likely to have cardiovascular disease and end-stage renal disease, respectively, and have at least twice the risk for psychiatric comorbidities (e.g., depression) than people of comparable age without SLE (Manzi et al. AJE 1997; Choi et al. Medicine 2019)). These and other chronic conditions have emerged as factors contributing to the excess morbidity and shorter lifespan of patients with SLE. To date, characterization of age-, disease- and treatment-related comorbidities associated with SLE has relied almost exclusively on individual comorbidity assessment. We aimed to compare the prevalence of multimorbidity in SLE patients with the general population.

Methods: Prevalent cases of SLE who met the ACR/EULAR classification criteria and were residents in a 27-county area of the United States on January 1, 2015 were included in the study. SLE patients were age-, sex-, race-, and county-matched to subjects from the same underlying population. Diagnosis codes within a five-year lookback period were used to determine the presence of comorbidities; 2 or more codes at least 30 days apart were used to define a comorbidity. A previously published list of 44 comorbidities was considered (England et al. ARD 2020). SLE and cutaneous lupus codes were excluded from the analysis. We defined multimorbidity as the presence of 2 or more comorbidities (excluding SLE) and substantial multimorbidity as the presence of 5 or more comorbidities. Logistic regression models adjusted for age and sex were performed.

Results: A total of 479 SLE patients were matched to 479 non-SLE comparators. The mean age was 53.2 (SD 16.2) years and 82.3% were female. 86% were non-Hispanic White. Patients with SLE had 5.3 comorbidities compared to 2.9 among non-SLE subjects. Multimorbidity was present in 78.5% SLE vs. 57.8% non-SLE subjects (OR 2.96; 95%CI 2.2-4.0) and substantial multimorbidity was present in 47.6% SLE patients vs. 25.5% non-SLE subjects (OR 3.06; 95%CI 2.28-4.1). Of the 44 conditions examined, 27 were more common in SLE than in non-SLE (Table).

Conclusion: In this population-based cohort, patients with SLE were 3 times as likely to suffer from multimorbidity and substantial multimorbidity compared to the general population. Most comorbidities were overrepresented in SLE patients. These findings highlight the complex care needs of SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/multimorbidity-prevalence-in-systemic-lupus-erythematosus-a-population-based-study/