Brief Report: Lupus—An Unrecognized Leading Cause of Death in Young Females: A Population‐Based Study Using Nationwide Death Certificates, 2000–2015

Yen, Eric Y; Singh, Ram Raj

doi:10.1002/art.40512

Cited by 208 publications

(154 citation statements)

References 6 publications

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“…Compared to White women, the US Black women are up to seven times more likely to develop renal failure, and two to three times as likely to die prematurely [4,7]. SLE is also a leading chronic disease cause of death in the US women ages 18-25 [8]. Arguing against a purely biological mechanism, higher SLE damage was noted in the US African descendants but not in other African descendants in ten other countries in the SLICC cohort [9].…”

Section: Introductionmentioning

confidence: 93%

Investigating lupus retention in care to inform interventions for disparities reduction: an observational cohort study

et al. 2020

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Background: Systemic lupus erythematous (SLE) disproportionately impacts patients of color and socioeconomically disadvantaged patients. Similar disparities in HIV were reduced through a World Health Organization-endorsed Care Continuum strategy targeting "retention in care," defined as having at least two annual visits or viral load lab tests. Using similar definitions, this study aimed to examine predictors of lupus retention in care, to develop an SLE Care Continuum and inform interventions to reduce disparities. We hypothesized that Black patients and those residing in disadvantaged neighborhoods would have lower retention in care. Methods: Abstractors manually validated 545 potential adult cases with SLE codes in 2013-2014 using 1997 American College of Rheumatology (ACR) or 2012 Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) criteria. We identified 397 SLE patients who met ACR or SLICC criteria for definite lupus, had at least one baseline rheumatology visit, and were alive through 2015. Retention in care was defined as having two ambulatory rheumatology visits or SLE labs (e.g., complement tests) during the outcome year 2015, analogous to HIV retention definitions. Explanatory variables included age, sex, race, ethnicity, smoking status, neighborhood area deprivation index (ADI), number of SLE criteria, and nephritis. We used multivariable logistic regression to test our hypothesis and model predictors of SLE retention in care. Results: Among 397 SLE patients, 91% were female, 56% White, 39% Black, and 5% Hispanic. Notably, 51% of Black versus 5% of White SLE patients resided in the most disadvantaged ADI neighborhood quartile. Overall, 60% met visit-defined retention and 27% met complement lab-defined retention in 2015. Retention was 59% lower for patients in the most disadvantaged neighborhood quartile (adjusted OR 0.41, CI 0.18, 0.93). No statistical difference was seen based on age, sex, race, or ethnicity. More SLE criteria and non-smoking predicted greater retention.

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Section: Introductionmentioning

confidence: 93%

Investigating lupus retention in care to inform interventions for disparities reduction: an observational cohort study

et al. 2020

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“…SLE remains one of the most challenging autoimmune rheumatic diseases to diagnose in rheumatology practice and is a leading cause of death in young females 1. The difficulties in the ability of healthcare providers to make a diagnosis of SLE is primarily related to the low prevalence of the disease and the heterogeneity of symptoms that are often non-specific and overlapping with many other conditions such as fibromyalgia 2.…”

Section: Introductionmentioning

confidence: 99%

Randomised prospective trial to assess the clinical utility of multianalyte assay panel with complement activation products for the diagnosis of SLE

Wallace

Alexander²,

O'Malley³

et al. 2019

Lupus Sci Med

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ObjectiveWe compared the physician-assessed diagnostic likelihood of SLE resulting from standard diagnosis laboratory testing (SDLT) to that resulting from multianalyte assay panel (MAP) with cell-bound complement activation products (MAP/CB-CAPs), which reports a two-tiered index test result having 80% sensitivity and 86% specificity for SLE.MethodsPatients (n=145) with a history of positive antinuclear antibody status were evaluated clinically by rheumatologists and randomised to SDLT arm (tests ordered at the discretion of the rheumatologists) or to MAP/CB-CAPs testing arm. The primary endpoint was based on the change in the physician likelihood of SLE on a five-point Likert scale collected before and after testing. Changes in pharmacological treatment based on laboratory results were assessed in both arms. Statistical analysis consisted of Wilcoxon and Fisher’s exact tests.ResultsAt enrolment, patients randomised to SDLT (n=73, age=48±2 years, 94% females) and MAP/CB-CAPs testing arms (n=72, 50±2 years, 93% females) presented with similar pretest likelihood of SLE (1.42±0.06 vs 1.46±0.06 points, respectively; p=0.68). Post-test likelihood of SLE resulting from randomisation in the MAP/CB-CAPs testing arm was significantly lower than that resulting from randomisation to SDLT arm on review of test results (−0.44±0.10 points vs −0.19±0.07 points) and at the 12-week follow-up visit (−0.61±0.10 points vs −0.31±0.10 points) (p<0.05). Among patients randomised to the MAP/CB-CAPs testing arm, two-tiered positive test results associated significantly with initiation of prednisone (p=0.034).ConclusionOur data suggest that MAP/CB-CAPs testing has clinical utility in facilitating SLE diagnosis and treatment decisions.

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“…Systemic lupus erythematosus (SLE [MIM: 601744]) is a chronic inflammatory autoimmune disease characterized by a wide spectrum of signs and symptoms varying among affected individuals and can involve many organs and systems, including the skin, joints, kidneys, lungs, central nervous system, and haematopoietic system (1). A recent report underscores that SLE is among the leading causes of death in young females, particular females among ages 15-24 years, in which SLE ranked tenth in the leading causes of death in all populations and fifth for African American and Hispanic females (2). Lupus nephritis is the most common cause of morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Genome-wide assessment of genetic risk for systemic lupus erythematosus and disease severity

Chen

Wang

Liu

et al. 2019

Preprint

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Objective: Using three European and two Chinese genome-wide association studies (GWAS), we investigated the performance of genetic risk scores (GRS) for predicting the susceptibility and severity of Systemic lupus erythematosus (SLE), using renal disease as a proxy for severity. Methods:We used four GWASs to test the performance of GRS both cross validating within the European population and between European and Chinese populations. The performance of GRS in SLE risk prediction was evaluated by Receiver Operating Characteristic (ROC) curves. We then analyzed the polygenic nature of SLE statistically. We also partitioned patients according to their age-of-onset and evaluated the predictability of GRS in disease severity in each age group. Results:We found consistently that the best GRS in the prediction of SLE used SNPs associated at the level of P<1e-05 in all GWAS datasets and that SNPs with P-values above 0.2 were inflated for SLE true positive signals. The GRS results in an area under the ROC curve ranging between 0.64 and 0.72, within European and between the European and Chinese populations. We further showed a significant positive correlation between a GRS and renal disease in two independent European GWAS (P cohort1 =2.44e-08; P cohort2 =0.00205) and a significant negative correlation with age of SLE onset (P cohort1 =1.76e-12; P cohort2 =0.00384). We found that the GRS performed better in prediction of renal disease in the 'later onset' compared to the 'earlier onset' group. Conclusion:The GRS predicts SLE in both European and Chinese populations and correlates with poorer prognostic factors: young age of onset and lupus nephritis.

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Brief Report: Lupus—An Unrecognized Leading Cause of Death in Young Females: A Population‐Based Study Using Nationwide Death Certificates, 2000–2015

Abstract: SLE is among the leading causes of death in young females, underscoring its impact as an important public health issue.

Cited by 208 publications

References 6 publications

Investigating lupus retention in care to inform interventions for disparities reduction: an observational cohort study

Investigating lupus retention in care to inform interventions for disparities reduction: an observational cohort study

Randomised prospective trial to assess the clinical utility of multianalyte assay panel with complement activation products for the diagnosis of SLE

Genome-wide assessment of genetic risk for systemic lupus erythematosus and disease severity

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