Background/Purpose: Patients with systemic lupus erythematosus (SLE) are at higher risk of complications such as heart attack and renal disease. We aimed to estimate all-cause mortality, all-cause hospitalization, and SLE-related complications in US Medicare patients with SLE, 2011-2015.

Methods: We identified SLE patients during 2010-2015 in the 20% Medicare sample, requiring Medicare Parts A/B coverage, no Medicare Advantage, and being alive for the entire preceding year and through the SLE index date. Using ICD-9 diagnosis code 710.0 and ICD-10 codes M32.1, M32.8, and M32.9 (for 2015), we defined SLE by presence of a diagnosis code on ≥1 inpatient or ≥2 outpatient claims separated by ≥30 days. The first SLE claim date during 2011-2015 was defined as the SLE index date. Chronic kidney disease (CKD) or end-stage renal disease (ESRD) before the SLE index date was identified. Follow-up was from the SLE index date until death, end of Medicare coverage, or December 31, 2015. Outcomes included all-cause death, all-cause first hospitalization, hospitalization due to myocardial infarction (MI) or stroke, CKD defined from all claim sources, or ESRD. Unadjusted mortality and event rates are reported as number of deaths or events per 100 patient-years.

Results: We identified 38,669 Medicare beneficiaries with SLE during 2011-2015. Mean age was 63.6 (±14.8) years, 87.5% were female, 72.5% were white, and 20.4% were black. The mean and median follow-up was 2.9 years and the maximum was 5 years after the SLE index date. Unadjusted results are presented in Table 1 overall and by sex. Overall all-cause mortality was 8.17 (7.61%) during the first year and 6.41 (18.34%) during 5 years. In the first year of follow-up, the overall all-cause hospitalization rate was 48.81; rates were 1.79 due to MI and 3.88 due to stroke. Incidence of CKD was 11.93, and incidence of ESRD was 0.81. Within 5 years, 1.73% of SLE patients developed ESRD and 2.68% developed shingles. Compared with women with SLE in 5-year follow-up, men were more likely to die (25.72% vs. 17.28%), be admitted for MI (5.44% vs. 3.71%) or stroke (9.01% vs. 7.49%), and develop CKD (25.99% vs. 20.19%) or ESRD (2.39% vs. 1.63%).

Table 1. All-cause death and complications in 2011-2015 Medicare patients with SLE

Conclusion: Medicare beneficiaries with SLE experienced high mortality and SLE-related complications, including MI, stroke, renal disease, and shingles. Effective SLE treatment and prevention of SLE-related complications are needed in the aging Medicare population.