Mortality Among Hospitalized Individuals With Systemic Lupus Erythematosus in the US Between 2006 and 2016

Abstract

Objective To evaluate time trends in mortality for hospitalized adults with systemic lupus erythematosus (SLE) compared to the general hospitalized population (GHP), and to identify factors associated with increased risk of death among hospitalized SLE patients. Methods We used the National (Nationwide) Inpatient Sample to estimate all‐cause mortality for adults discharged from community hospitals in the US between 2006 and 2016. Poisson regression models were used to estimate the risk of in‐hospital death among all patients, including demographic characteristics, socioeconomic factors, comorbidity score, hospital region, SLE diagnosis, and race/ethnicity as covariates. Results Among 340,467,049 hospitalizations analyzed, 1,903,279 had a discharge diagnosis of SLE. In adjusted analysis, the risk of inpatient death decreased among hospitalizations for patients with SLE from 2.2% to 1.5% (P < 0.001) between 2006 and 2016. All of the decrease in SLE mortality occurred between 2006 and 2008; after 2008, mortality stabilized at a rate statistically similar to the GHP. Hospitalizations for Black, Hispanic, and Asian/Pacific Islander patients with SLE were more likely to end in death compared to hospitalizations for either White patients with SLE or individuals of the same non‐White race/ethnicity without SLE. Conclusion In the largest study of in‐hospital SLE mortality published to date, we found significant improvements in mortality for hospitalized patients with SLE in the US from 2006 until 2008, after which mortality stabilized at a level similar to that of the GHP. Our results also demonstrate a persistently high mortality burden among Black and Hispanic patients with SLE in the US and contribute new data revealing high mortality among Asian/Pacific Islander patients with SLE.

Trends in all-cause hospitalizations for systemic lupus erythematosus in Mexico, 2000–2019

“…As other studies have reported, we also identified a reduction in the length of hospital stay, 16,18 possibly reflecting an improvement in the management of SLE. On the other hand, although there was a significant reduction in the frequency of inpatient deaths between 2000 and 2019, the frequency of 6.1% is higher than in a previous analysis in the same time period (1.5%), 16,19 indicating that more effective health care strategies promoting better outpatient management in order to prevent hospital admission for those patients are necessary.…”

Trends in Hospital Admissions and Death Causes in Patients with Systemic Lupus Erythematosus: Spanish National Registry

“…On the other hand, other studies have shown a significant downward trend in SLE-related admissions [19,[27][28][29]. Recently, Anastisou et al reported a decreasing risk of inpatient death in US lupus patients from 2006 to 2016 [29].…”

“…Several studies have identified SLE itself as the main cause of hospital admission, with a wide range between 8.1 and 86.3% [17][18][19][20][21][22][23][24][25][26]. On the other hand, other studies have shown a significant downward trend in SLE-related admissions [19,[27][28][29]. Recently, Anastisou et al reported a decreasing risk of inpatient death in US lupus patients from 2006 to 2016 [29].…”

Central nervous system infections in patients with systemic lupus erythematosus: a systematic review and meta-analysis

“…[3][4][5] Infections account for 13%-37% of hospitalisations and 15.1%-37.5% of deaths in major SLE cohorts. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Patients with SLE have a five times higher risk of death due to infections than the general population. 12 Factors associated with impaired immune response in patients with SLE include T cell and natural killer cell dysfunction as well as complement deficiencies.…”