Background/Purpose: The care of patients with Systemic Lupus Erythematosus (SLE) is challenging, and with the emergency of newer disease modifying medications, clinical outcomes in these patients may be positively affected. We conducted a trend analysis of in-hospital outcomes of patients admitted for SLE within a 10-year period, with a specific emphasis on racial differences in mortality.

Methods: Using 2010 to 2019 National Inpatient Sample data, we identified SLE related admissions based on International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification codes. Primary outcomes of interest were in-hospital mortality, length of hospital stay, and total hospital charges trends over the last 10 years in all patients admitted with a principal diagnosis of SLE. Secondary outcome of interest was in-hospital mortality as it pertains to race. Weighted national estimates of admissions were used to assess trends over time using logistic regression. A p-value of < 0.05 was considered as statistically significant.

Results: We identified a total number of 111,192 admissions between 2010 and 2019 with a primary diagnosis of SLE. A decrease in SLE admissions was observed over the period, from 13,283.57/year [11207.94 – 15359.2] to 10025/year [9197.68 – 10852.3] over the last 10 years. Mean (SD) admission age has increased from 37.4 (0.5) to 38.3 (0.4) years, coefficient 0.01 [ -0.08 – 0.100]. p=0.824. The proportion of admitted female patients slightly reduced from 88.7% to 87.2%, p=0.311. There was a downward trend in in-hospital mortality of 0.2% from 1.3% to 1.1%, p=0.288. Mean (SD) length of hospital stay (LOS) slightly reduced from 6.5 (0.2) days to 6.4 (0.2) days and mean (SD) total hospital charge increased from $55,950.2 ($3273) to $72,445.9 ($3023.9). With increasing years, the odds of in-hospital mortality were AOR 1.01 (CI: 0.97 – 1.06) p=0.664. As compared to age 18 – 44 years, those 45 – 64 years of age, ≥ 65 years of age were increasingly more likely to experience in-hospital mortality AOR 2.09 (CI: 1.58 – 2.78), p< 0.001 and AOR 4.65 (CI: 3.23 – 6.69), p< 0.001 respectively. Females as compared to males were not more likely to experience in-hospital mortality AOR 0.82 (CI: 0.58 – 1.17), p=0.276. As compared to non-Hispanic whites, non-Hispanic blacks/African Americans AOR 1.13 (CI: 0.82 – 1.56), p=0.466, Hispanics AOR 1.05 (CI: 0.70 – 1.59), p=0.814), and Non-Hispanic Others AOR 1.54 (CI:1.04 – 2.28), p=0.032.  

Conclusion: Over the last 10 years, there has been a trend towards an increase in SLE-related admissions, with an associated increase in the age of the admitted patient population, and a downward trend in the proportion of admitted female patients. LOS and mortality show a downward trend while mean hospital charges as increased. The observed trends are likely due to an increase in SLE-related admission is likely related to an improvement in the diagnosis of SLE over the years while the increase trend in costs may be related to the overall increase in the cost of health care over the years. Increasing age and some minority race is associated with a higher probability of in-hospital mortality. This highlights the existing disparity in the care of patients with SLE

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/demographic-differences-in-trends-of-systemic-lupus-erythematosus-in-hospital-patient-outcomes/