Background/Purpose: Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease with manifestations that vary widely in severity. Data indicate that minority populations are at higher risk of developing SLE and have more severe outcomes, including mortality. However, whether specific causes of death vary by race and ethnicity has largely been unexplored, particularly for Asians and Hispanics.

Methods: The California Lupus Surveillance Project identified potential SLE cases using community rheumatology and nephrology clinics, community hospitals, and integrated healthcare systems among individuals who were residents of San Francisco County, CA during January 1, 2007 – December 31, 2009. SLE cases were defined using American College of Rheumatology Classification Criteria (≥4 of the 11 revised criteria as defined in 1982 and updated in 1997) or two alternative definitions: SLE diagnosed by the patient’s treating rheumatologist plus 3 ACR criteria; or lupus-related kidney disease (World Health Organization class II-VI lupus nephritis upon biopsy or documented record of SLE diagnosis and dialysis or renal transplantation). Cases were matched to the 2007-2017 National Death Index (NDI) data, which included the underlying cause of death for each individual. Chi-squared tests were used to examine differences in underlying cause of death by race (white, Black, Asian), ethnicity (Hispanic, non-Hispanic), and sex (female, male). Age-standardized mortality ratios (SMRs) between SLE patients and the general San Francisco county population were calculated for the leading cause of death, and estimated observed versus expected deaths by sex, race, and Hispanic/Latino ethnicity.

Results: During the study time period, 812 deaths related to SLE were identified. Cardiovascular disease (CVD) was the leading cause of death among SLE patients overall (33%), and across all racial and ethnic groups. Other top causes included rheumatic disease (18%) and hematological/oncological conditions (18%) overall, and across all racial groups. Overall, CVD as the underlying cause of death was over three times higher among SLE cases than in the general population of San Francisco County (SMR=3.63) (Table 1). CVD deaths for those with SLE were nearly four times higher for Asians and over six times higher for Hispanic/Latinos. CVD deaths were also elevated for females (SMR=4.7) and males (SMR=3.5) with SLE compared with their non-SLE counterparts.

Conclusion: These findings indicate that CVD is the leading underlying cause of death among SLE patients across various racial and ethnic groups, and that SLE patients experience a disproportionate burden of CVD mortality compared with the general population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/causes-of-death-among-populations-with-systemic-lupus-erythematosus-by-race-and-ethnicity/