Background/Purpose: Systemic Lupus Erythematosus (SLE) and Cutaneous Lupus Erythematosus (CLE) are chronic autoimmune diseases with significant morbidity and mortality, collectively accounting for approximately 5,000 deaths annually in the United States. Understanding long-term mortality trends can inform clinical management strategies and public health policies aimed at reducing mortality and addressing disparities across populations. This study analyzes national mortality data from 1999 to 2020 to compare demographic and geographic disparities in deaths associated with SLE and CLE. The goal is to identify at-risk populations and inform future interventions to improve outcomes and reduce preventable deaths.

Methods: Age-adjusted mortality rates (AAMRs) per 1,000,000 adults were calculated using CDC WONDER data. Deaths attributed to SLE were identified using ICD-10 code M32, while CLE-related deaths included codes L93.0 (discoid lupus), L93.1 (subacute cutaneous lupus), and L93.2 (other local lupus). Age-stratified trends were examined in 10-year intervals. Joinpoint regression analysis was used to estimate annual percent change (APC) and average annual percent change (AAPC) in mortality from 1999 to 2020.

Results: From 1999 to 2020, mortality rates for both systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE) declined overall. However, deaths from SLE remained consistently higher than those from CLE. During this period, there were 47,337 recorded deaths due to SLE and 24,563 due to CLE. The average age-adjusted mortality rate (AAMR) for SLE was 6.6 per million, compared to 3.4 per million for CLE. Mortality rates were higher in females for both conditions, with a particularly large gap in SLE—10.7 in females versus 2.2 in males. Racial disparities were evident as well: non-Hispanic Black individuals had the highest mortality for both SLE (17.4) and CLE (7.4), followed by Native Americans. Urban areas saw slightly higher SLE mortality (6.6) than rural areas (6.4), while the opposite was true for CLE, with rural areas showing a higher rate (4.1 vs. 3.3). Regionally, SLE mortality was highest in the West and lowest in the Northeast, whereas CLE mortality peaked in the South and was lowest in the Northeast. Among states, Oklahoma reported the highest SLE mortality (10.8), while Arkansas had the highest for CLE (6.9).

Conclusion: Although overall mortality rates for SLE and CLE have declined over the past two decades, marked disparities persist by sex, race, and geography. SLE disproportionately affects females, NH Black individuals, urban populations, and those residing in the Western U.S. Conversely, CLE mortality is highest among females, NH Blacks, rural populations, and those in the Southern U.S.These findings underscore the need for state-specific interventions, improved access to rheumatologic care, and targeted public health strategies. Enhanced screening, early diagnosis, and equitable healthcare access are essential for reducing disease burden and closing existing mortality gaps. Future research should explore the underlying causes of these disparities and evaluate the impact of proposed interventions.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-mortality-trends-in-adults-with-systemic-lupus-erythematosus-and-cutaneous-lupus-erythematosus-a-21-year-analysis-using-cdc-wonder-database/