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Abstract Number: 2131

Prevalence of Systemic Lupus Erythematosus (SLE) and Associated Comorbidities in the 2011-2015 Medicare Population

Suying Li, Tingting Gong, Yi Peng, Kimberly M. Nieman and David T. Gilbertson, Minneapolis Medical Research Foundation, Chronic Disease Research Group, Minneapolis, MN

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Co-morbidities, Medicare and systemic lupus erythematosus (SLE)

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Session Information

Date: Tuesday, October 23, 2018

Session Title: Epidemiology and Public Health Poster III: SLE, SSc, APS, PsA, and Other Rheumatic Diseases

Session Type: ACR Poster Session C

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

Background/Purpose: Prevalence of systemic lupus erythematosus (SLE) has been estimated in different US regions. An estimate based on the 2005 US population showed SLE affecting 161,000-322,000 adults (Helmick et al., 2008). We aimed to update estimates of SLE prevalence and associated comorbidity in the US Medicare population.

Methods: We used the 2010-2015 20% Medicare sample data. For each year (2011-2015), we required patients to have Medicare Parts A/B coverage, not have Medicare Advantage, and be alive for the entire preceding year and through the first day of the year. 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 baseline period, 1 year before each SLE cohort year, was used to define comorbid conditions including: anemia, chronic kidney disease (CKD), end-stage renal disease (ESRD), glomerulonephritis (GN), rheumatoid arthritis (RA), etc. SLE prevalence was reported as the number of SLE patients per 1000 Medicare population.

Results: We included ~6 million Medicare beneficiaries each year. Demographics and baseline characteristics were similar across years. In the 2015 cohort (Table 1), SLE patient mean age was 63.7 (±14.9) years, 89.4% were female, 21.9% were black; comorbidity percentages were 32.5% anemia, 26.0% CKD, 7.1% ESRD, and 17.9%  RA. Non-SLE patient mean age was 72.3 (±12.6) years, 56.9% were female, 9.4% were black; comorbidity percentages were 13.8% anemia, 11.3% CKD, 1.2% ESRD, and 1.9% RA. Average SLE prevalence was 3.4 (Table 2). Prevalence was higher for ages <45 years, women, and black patients, and for patients with baseline conditions. For example in 2014, SLE prevalence in patients with the following conditions was 37.6, GN; 31.6, RA; 20.5, ESRD; 13.6, psoriatic arthritis; 11.1, Crohn disease; and 10.5, liver disease.

Conclusion: Average SLE prevalence was 3.4 per 1000 Medicare beneficiaries. Prevalence in patients with kidney-related diseases or arthritis was 3-10 times the average. These results underscore the need for effective treatment and management of comorbid conditions and of SLE in the aging Medicare population.

Table 1. Baseline Characteristics and Comorbid Conditions in 2015 20% Medicare Sample

 

Non-SLE

SLE

P value

 

%

N

%

N

 

All

 

6,333,180

 

21,652

 

Age (Mean years, SD)

72.3 (12.6)

 

63.7 (14.9)

 

<.0001

Female

56.9

3,603,533

89.4

19,356

<.0001

White

84.2

5,330,297

70.2

15,205

<.0001

Black

9.4

594,500

21.9

4,734

Other race

6.4

408,383

7.9

1,713

Comorbid conditions

 

 

 

 

 

  Diabetes

23.4

1,481,478

23.8

5,161

0.1236

  Arteriosclerotic Heart Disease

16.2

1,023,519

19.5

4,217

<.0001

  Congestive Heart Failure

8.2

519,513

14.0

3,021

<.0001

  Peripheral Vascular Disease

10.6

674,466

19.9

4,318

<.0001

  Anemia

13.8

874,419

32.5

7,030

<.0001

  Hypertension

54.1

3,427,585

66.0

14,298

<.0001

  CKD

11.3

716,876

26.0

5,621

<.0001

  ESRD

1.2

75,825

7.1

1,536

<.0001

  Liver Disease

1.2

76,463

3.6

784

<.0001

Inflammatory conditions

 

 

 

 

 

  Glomerulonephritis

0.5

31,568

5.2

1,122

<.0001

  Chronic Infection

0.6

38,046

1.3

271

<.0001

  Crohn Disease

0.3

18,348

0.9

185

<.0001

  Ulcerative colitis

0.3

18,397

0.7

150

<.0001

  Gout

2.6

166,225

4.0

874

<.0001

  Rheumatoid Arthritis

1.9

122,795

17.9

3,871

<.0001

  Psoriasis

0.5

34,271

1.1

237

<.0001

  Psoriatic Arthritis

0.2

10,804

0.7

144

<.0001

Table 2. Prevalence of SLE in 2011-2015 20% Medicare Sample, Overall and by Demographics and Selected Conditions

Cohort year

2011

2012

2013

2014

2015

Eligible Medicare beneficiaries in the 20% sample

5,871,667

5,884,921

5,935,011

6,000,841

6,354,832

N with SLE in the 20% sample

19,299

20,071

20,557

21,212

21,652

 

Number of SLE per 1000 population

Overall

3.29

3.41

3.46

3.53

3.41

Age

 

 

 

 

 

  <45 years

9.98

10.40

10.51

10.72

10.48

  45-64 years

8.75

8.81

8.83

8.95

8.69

  65-74 years

2.50

2.61

2.63

2.72

2.65

  75-84 years

1.94

2.02

2.09

2.10

2.19

  85+ years

1.01

1.10

1.15

1.17

1.21

Gender

 

 

 

 

 

  Male

0.85

0.85

0.86

0.87

0.84

  Female

5.20

5.45

5.56

5.70

5.34

Race

 

 

 

 

 

  White

2.76

2.86

2.89

2.95

2.84

  Black

7.48

7.73

7.96

8.07

7.90

  Other race

3.88

4.13

4.14

4.27

4.18

Selected Conditions

 

 

 

 

 

    Glomerulonephritis

39.70

37.91

37.31

37.61

34.32

    Rheumatoid Arthritis

28.35

30.30

30.89

31.55

30.56

    End-stage renal disease including transplant

19.41

19.23

19.77

20.46

19.85

    Psoriatic Arthritis

12.48

13.71

12.91

13.59

13.15

    Crohn Disease

11.17

12.10

11.12

11.07

9.98

    Liver Disease

10.17

9.67

10.46

10.53

10.15

    Anemia

7.37

7.68

7.94

8.17

7.98

    Ulcerative colitis

7.18

7.38

6.21

8.02

8.09

    Chronic kidney disease

7.76

7.83

8.04

8.00

7.78

    Chronic Infection

6.82

6.98

7.19

6.75

7.07

    Psoriasis

5.87

5.53

5.69

5.76

6.87

    Hypertension

3.88

4.06

4.15

4.26

4.15

 


Disclosure: S. Li, None; T. Gong, None; Y. Peng, None; K. M. Nieman, None; D. T. Gilbertson, None.

To cite this abstract in AMA style:

Li S, Gong T, Peng Y, Nieman KM, Gilbertson DT. Prevalence of Systemic Lupus Erythematosus (SLE) and Associated Comorbidities in the 2011-2015 Medicare Population [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/prevalence-of-systemic-lupus-erythematosus-sle-and-associated-comorbidities-in-the-2011-2015-medicare-population/. Accessed October 21, 2022.
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