Rising incidence and prevalence of systemic lupus erythematosus: a population-based study over four decades

Abstract

ObjectivesTo determine the trends in incidence, prevalence and mortality of systemic lupus erythematosus (SLE) in a US population over four decades.MethodsWe identified all the patients with SLE in Olmsted County, Minnesota who fulfilled the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria for SLE during 1976–2018. Age-specific and sex-specific incidence and prevalence dates were adjusted to the standard 2000 projected US population. The EULAR/ACR score was used as a proxy for disease severity. Standardised mortality ratio (SMR) was estimated.ResultsThere were 188 incident SLE cases in 1976–2018 (mean age 46.3±SD 16.9; 83% women). Overall age-adjusted and sex-adjusted annual SLE incidence per 100 000 population was 4.77 (95% CI 4.09 to 5.46). Incidence was higher in women (7.58) than men (1.89). The incidence rate increased from 3.32 during 1976–1988 to 6.44 during 2009–2018. Incidence rates were higher among the racial and ethnic minority populations than non-Hispanic whites. The EULAR/ACR score did not change significantly over time. Overall prevalence increased from 30.6 in 1985 to 97.4 in 2015. During the study period, there was no improvement in SMR over time (p=0.31).ConclusionsThe incidence and prevalence of SLE are increasing in this US population. The increase in incidence may be at least partially explained by the rising ethnic/racial diversity of the population. There was no evidence that the severity of SLE has changed over time. The survival gap between SLE and the general population remains unchanged. As the US population grows more diverse, we might continue to see an increase in the incidence of SLE.

The global epidemiology of SLE: narrowing the knowledge gaps

“…Recent updates from the CDC registry in Olmsted, MN, USA provide insight into long-term epidemiology, suggesting an increase in SLE prevalence and incidence over four decades [ 14 ]. All individuals in Olmsted who fulfilled 2019 EULAR/ACR classification criteria for SLE [ 15 ] from 1976 to 2018 were exhaustively identified using International Classification of Diseases (ICD) codes, laboratory results and medical records.…”

“…The overall prevalence per 100 000 increased from 30.7 (95% CI 18.9, 42.4) in 1985 to 97.4 (95% CI 81.6, 113.2) in 2015. The authors suggested that this increase in incidence and prevalence may partially relate to increasing ethnic/racial diversity in the region under study, with the percentage of non-Hispanic White patients decreasing from 100% in 1976–1988 to70% in 2009–2018 [ 14 ]. There were no significant improvements in mortality rate, with a standardized mortality ratio (SMR) of 1.8 (95% CI 1.0, 3.0) from 1977–1988 for SLE patients compared with the general population and 2.9 (95% CI 1.4, 5.2) from 2009–2018 [ 14 ].…”

Immunosuppressant Responsive Neuropsychiatric Systemic Lupus Erythematosus Manifestations Initially Diagnosed As Schizophrenia and Bipolar Disorder

“…A greater prevalence of SLE is noted among women of minority ethnicities and races such as American Native, Asian, Black, Hispanic, and Latino [1]. In the United States, SLE has an incidence of 5.1 per 100,000 and an estimated prevalence of 97.4 per 100,000 [1,3].…”

Race, Toxic Exposures, and Environmental Health: The Contestation of Lupus among Farmworkers

“…Studies have found varying ranges from 72.8 per 100,000 people (Izmirly, Parton, et al 2021) to 241 per 100,000 people in the United States (Leng et al 2020). A recently published study found evidence that lupus rates in the United States have increased over time (1976 to 2018) but suggest the rate increase may be explained by changing population demographics (Duarte-García et al 2022). Indeed, studies have consistently found that lupus rates are highest among women (9 times higher than men), particularly women of color, with a prevalence estimate of 230.9 per 100,000 people (Izmirly, Parton, et al 2021; see also Parks et al 2017).…”