Background/Purpose: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with incidence and prevalence well studied and documented worldwide. Lupus nephritis (LN) is a severe manifestation of SLE causing dramatic morbidity and mortality. We performed a study looking at large epidemiologic database and found that the information differed from what has been reported in clinical literature. Since healthcare cost distribution is often determined on the basis of large 3^rdparty payer or government databases rather than data from academic clinical investigative studies, the social and demographic information from this study would have an important impact on how health resources are allocated.

Methods: The worldwide pattern of LN prevalence and socio-demographic influences were identified by combining the information from Kantar’s Epi Database®, the National Health and Wellness Survey (NHWS) and available original research literatures. The association between the prevalence of LN and potential socio-economic factors was assessed for the United States and Europe (France, Germany, Italy, Spain and the United Kingdom) using a stratification-projection algorithm strategy commonly used for rare diseases. The LN diagnostic criteria in WHO served to define patients. All statistical tests on differences were conducted using Student’s t-test or the Chi-square approach.

Results: The overall prevalence rate adjusted by gender and age equaled 40.9 per 100,000 patients in the US, but the averaged rate in Europe (15.7) was lower than half of the US (p=0.03), with specific numbers as 16.1 in France, 11.2 in Germany, 28 in Italy, 13 in Spain and 10.3 in the UK. In the US, patients ages 31-60 were at higher risk (58%) to develop LN. Female gender presented as a major risk factor (84%, p=0.02). Only 2% of the cases were pediatric patients (0-15 years old, p=0.01). Almost half of prevalent cases were black patients (46%), followed by Whites (27%) and Hispanics (20%). Geographically, the southern region was dominant in LN prevalence (42%) with the vast majority in urban areas (85%). Around 40% of LN patients were commercially insured through employers, followed by Medicare (34%) and Medicaid (13%), while self-insured subjects accounted for only 6%. Within Europe, the socio-demographic breakdown of LN by region and ethnicity was complex and country specific, but the patterns in gender and age distributions were similar to those in the US. LN patients were mainly insured by national public plans (60-86%).

Conclusion: The prevalence rates of LN in the US and Europe were very low. Female gender was a determinant factor contributing to higher LN prevalence. Adults were more likely to develop LN than children. Most patients were insured commercially in the US and by national health plans in Europe. Quantification and characterization of the LN population from epidemiologic database is key to informing treatment decisions, supporting new therapy development for this severely ill population as well as determining effecient health resource allocation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-in-depth-analysis-of-the-prevalence-and-socio-demographic-factors-associated-with-lupus-nephritis-in-major-industrialized-countries/