Background/Purpose: Current estimates for age of SLE onset are limited, particularly for males and racial/ethnic groups in the United States. Leveraging five Centers for Disease Control and Prevention population-based SLE surveillance registries, which were developed to provide epidemiologic data for SLE across diverse regions of the US, we performed meta-analyses to estimate the age-specific incidence of SLE, overall and by sex and race/ethnicity.

Methods: The registries in Georgia, California, New York and the Indian Health Service (IHS) used the 1997 revised ACR classification criteria while the registry in Minnesota used the EULAR/ACR classification criteria for SLE as their primary case definitions. The surveillance periods ranged from 2002 to 2018. Age-specific incidence of SLE stratified by sex and race/ethnicity was obtained from each registry. Given the small number of registries and near-complete case ascertainment from each site, we performed a fixed-effects meta-analysis to estimate the pooled incidence using inverse-variance weighting, stratified by sex and race/ethnicity (females only due to small sample sizes for males), across the four state sites. Given the IHS registry focused solely on the American Indian/Alaska Native (AI/AN) population, their data was included separately in the female racial/ethnic estimates and not as part of the pooled estimates. To examine age-specific patterns of diagnoses, we then estimated the percentage of all SLE patients diagnosed among each age group, 0-19, 20-29, 30-39, 40-49, 50-59, 60-69, ≥70 years, from all the registries, weighted by the number of person-years contributed by the five sites.

Results: The registries contributed 939 incident classified cases of SLE from a mix of urban and rural areas. The fixed-effects model yielded overall incidence rates of 9.6 (95%CI: 8.9-10.3) and 1.7 (95%CI: 1.4-2.0) per 100,000 person-years among females and males, respectively, Figure 1. Incidence rates among females were highest for those aged 30-39 (13.8, 95%CI: 12.0-16.0), while rates among males were highest for those aged 60-69 (3.1, 95%CI: 1.9-5.0). Black females aged 20-39 and 40-59 had the highest SLE incidence rates (24.2, 95%CI: 20.5-28.6) and (24.3, 95%CI: 20.3-29.3), Figure 2. Among females diagnosed with SLE before age 20, incidence was highest among Asian (7.2, 95%CI: 3.8-13.5) and Black (6.4, 95%CI: 4.5-9.1) individuals. Among females diagnosed with SLE after age 60, incidence was highest among Black (13.8, 95%CI: 9.5-20.0) and AI/AN (9.4, 95%CI: 3.4-15.4) individuals. Weighted percentages (Table 1) show that 7.8% of those with SLE were diagnosed before age 20, while 17.9% were diagnosed after age 60. The largest proportion of individuals with SLE, 22.2%, were diagnosed between 30 and 39 years.

Conclusion: In this coordinated network of population-based SLE registries, age-specific incidence rates were obtained, and data were provided on males and previously understudied age groups. While female incidence rates were highest during the reproductive years, the incidence rates for males increased with age with the highest rates at ages 60-69. Overall, 18% of patients with SLE were diagnosed after age 60 and nearly 8% before age 20.

Figure 1. SLE meta analysis incidence rates among females and males by age group.

Figure 2. SLE meta-analysis incidence rates by race and ethnicity and age group among females.

Age-Specific Patterns of Diagnoses

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/age-specific-incidence-of-systemic-lupus-erythematosus-in-the-united-states-a-meta-analysis-of-data-from-the-centers-for-disease-control-and-prevention-lupus-registries/