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Abstract Number: 273

Incidence of Systemic Lupus Erythematosus By Income: A Nationwide Study

Ali Duarte-Garcia1, Cynthia S. Crowson2, Rozalina McCoy1, Stephanie Schilz3, Holly Van Houten4, Lindsey Sangaralingham4, Vaidehi R. Chowdhary5, Shreyasee Amin6, Kenneth J. Warrington7, Eric L. Matteson8 and Nilay Shah9, 1Mayo Clinic College of Medicine and Science, Rochester, MN, 2Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, 3Health Sciences Research, Mayo Clinic, Rochester, MN, 4Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 5Internal Medicine, Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, 6Rheumatology, Mayo Clinic, Rochester, MN, 7Rheumatology, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, 8Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, 9Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: race/ethnicity, socioeconomic factors and systemic lupus erythematosus (SLE)

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Session Information

Date: Sunday, October 21, 2018

Session Title: Healthcare Disparities in Rheumatology Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: The incidence of systemic lupus erythematosus (SLE) varies significantly across patients from different racial/ethnic backgrounds, and is highest in non-Caucasian populations.  In addition, poverty has been associated with increased SLE severity and mortality, independent of race/ethnicity. How the incidence of SLE varies by income level, the main determinant of poverty, is unknown. 

Methods: Using OptumLabs Data Warehouse, a large administrative database of commercially insured and Medicare Advantage beneficiaries, we identified adults with newly diagnosed SLE (ascertained using three ICD-9/10 codes at least 30 days apart) from 2013-2017. Patients had at least two years of enrollment prior to SLE diagnosis. Patients of ≥65 years were excluded due to difficulty in estimating income after retirement. Income was based predominately on self-report or when data were missing, derived rule sets were used. Income was missing in 5% of the sample. We estimated the incidence rate (IR) of SLE per 100,000 person-years stratified by income and racial/ethnic categories with age- and sex-adjusted adjustment to the 2010 US total population aged 18-64 years.

Results: We identified 2810 patients with newly diagnosed SLE. The average age (SD) was 44.9 (12.5), 62% of the patients were Caucasian, 16% Black, 15% Hispanic, 7% Asian/other, and 88% were female.  The overall age-, sex- and race/ethnicity-adjusted IR was 3.4 (95% confidence interval: 3.3-3.5) per 100,000. SLE incidence was 8 times higher among women (9.1) than men (1.2). The incidence rate among Blacks was twice as high as that of Caucasians, and was moderately higher in Hispanic and Asian/other compared to Caucasians. SLE incidence was 12% higher in those with <$40,000 household income than those with ≥$40,000 income. Caucasians with <$40,000 income had 20% higher SLE incidence than those with ≥$40,000 income, but there was no evidence of a differential income effect among minorities  

Conclusion: The incidence of SLE is highest among Blacks, and Hispanics.  Lower income is associated with higher incidence of SLE in Caucasians; this differential effect of income on disease incidence was not seen in minorities.

Table. Incidence Rates of SLE per 100,000 person years according to income

Income

Overall

Caucasian

Black

Hispanic

Asian/Other

<$40,000

4.4

3.9

        6.0

5.7

3.9

$40000 – $99,000

3.8

3.3

6.0

5.7

3.4

$100,000+

3.8

3.2

5.9

5.4

3.8

Unknown

1.7

1.5

3.3

2.4

1.3

OVERALL

3.4

2.9

5.1

2.4

3.1


Disclosure: A. Duarte-Garcia, None; C. S. Crowson, None; R. McCoy, None; S. Schilz, None; H. Van Houten, None; L. Sangaralingham, None; V. R. Chowdhary, None; S. Amin, None; K. J. Warrington, GlaxoSmithKline, 2,Eli Lilly and Co., 2,Sanofi, 5; E. L. Matteson, None; N. Shah, None.

To cite this abstract in AMA style:

Duarte-Garcia A, Crowson CS, McCoy R, Schilz S, Van Houten H, Sangaralingham L, Chowdhary VR, Amin S, Warrington KJ, Matteson EL, Shah N. Incidence of Systemic Lupus Erythematosus By Income: A Nationwide Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/incidence-of-systemic-lupus-erythematosus-by-income-a-nationwide-study/. Accessed February 5, 2023.
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