Sex Differences in Health Care Utilization, End‐Stage Renal Disease, and Mortality Among Medicaid Beneficiaries With Incident Lupus Nephritis

Feldman, Candace H.; Broder, Anna; Guan, Hongshu; Yazdany, Jinoos; Costenbader, Karen H.

doi:10.1002/art.40392

Cited by 23 publications

(27 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overall, our results suggest a more severe phenotype in male SLE. In contrast to a recent publication [47], the majority of the patients in our study were of European descent, which entails that our findings could represent renal features specific for this population, but not necessarily other populations. In the study by Feldman et al [47], data were collected from the Medicaid Program, which introduces a selection bias.…”

Section: Discussioncontrasting

confidence: 88%

Sex differences in clinical presentation of systemic lupus erythematosus

et al. 2019

View full text Add to dashboard Cite

ObjectiveSystemic lupus erythematosus (SLE) predominantly affects women, but previous studies suggest that men with SLE present a more severe disease phenotype. In this study, we investigated a large and well-characterized patient group with the aim of identifying sex differences in disease manifestations, with a special focus on renal involvement.MethodsWe studied a Swedish multi-center SLE cohort including 1226 patients (1060 women and 166 men) with a mean follow-up time of 15.8 ± 13.4 years. Demographic data, disease manifestations including ACR criteria, serology and renal histopathology were investigated. Renal outcome and mortality were analyzed in subcohorts.ResultsFemale SLE patients presented more often with malar rash (p < 0.0001), photosensitivity (p < 0.0001), oral ulcers (p = 0.01), and arthritis (p = 0.007). Male patients on the other hand presented more often with serositis (p = 0.0003), renal disorder (p < 0.0001), and immunologic disorder (p = 0.04) by the ACR definitions. With regard to renal involvement, women were diagnosed with nephritis at an earlier age (p = 0.006), while men with SLE had an overall higher risk for progression into end-stage renal disease (ESRD) with a hazard ratio (HR) of 5.1 (95% CI, 2.1–12.5). The mortality rate among men with SLE and nephritis compared with women was HR 1.7 (95% CI, 0.8–3.8).ConclusionSLE shows significant sex-specific features, whereby men are affected by a more severe disease with regard to both renal and extra-renal manifestations. Additionally, men are at a higher risk of developing ESRD which may require an increased awareness and monitoring in clinical practice.

show abstract

Section: Discussioncontrasting

confidence: 88%

Sex differences in clinical presentation of systemic lupus erythematosus

et al. 2019

View full text Add to dashboard Cite

show abstract

“…An observational study found that compared with women with SLE, men with SLE had fewer outpatient visits and fewer emergency department visits. 16 The authors did not find an association between disparities in health care utilization and disease outcomes, but the effects of such disparities on disease outcomes remain underexplored.…”

Section: Differences In Male and Female Diseasementioning

confidence: 97%

“…Although men with SLE experience nephritis at a higher rate than women, progression to end-stage renal disease does not differ based on sex. 9,[11][12][13][14][15][16] Musculoskeletal involvement appears to be less common in men than in women. 7 The presence of lupus anticoagulant is more frequent in men, but other autoantibodies appear to occur at the same rate.…”

Section: Differences In Male and Female Diseasementioning

confidence: 99%

“…These contribute to poorer maternal and fetal outcomes in women with SLE compared with women in the general population. 31 In a large cohort of women in Sweden, 16 32 African American and Hispanic women experience a 2-fold greater incidence of adverse pregnancy outcomes than their white counterparts, which has been attributed to socioeconomic disparities but may also relate to racially associated genetic differences in SLE risk. 33,34 Factors that predict adverse outcomes, irrespective of disease control status, include nonwhite race, use of blood pressureelowering medications, low platelet count, presence of lupus anticoagulant, and a physician global assessment score higher than 1.…”

Section: Contraceptionmentioning

confidence: 99%

See 1 more Smart Citation

Sex Differences in Systemic Lupus Erythematosus

Nusbaum

Mirza

Shum

et al. 2020

Mayo Clinic Proceedings

112

View full text Add to dashboard Cite

Systemic lupus erythematosus (SLE) is a chronic, multiorgan, systemic autoimmune disease that is more common in women than men and is typically diagnosed during reproductive age, necessitating sex-specific considerations in care. In women there is no substantive evidence to suggest that SLE reduces fertility, but subfertility may occur as a result of active disease, immunosuppressive drugs, and age-related declines in fertility related to delays in childbearing. Although pregnancy outcomes have improved, SLE still poses risks in pregnancy that contribute to poorer maternal and fetal outcomes. Cyclophosphamide, an important agent for the treatment of severe or life-threatening lupus, may adversely affect fertility, particularly with increases in dose and patient age. Fertility

show abstract

“…Stratification by clinical and serological phenotypes , demography and habits is qualitative, on disease activity measures quantitative 50–57. Stratification on sex, race, socioeconomic status,58–62 access to medical care, medication choice and adherence,63 willingness to participate in clinical trials, doctor–patient interactions,64 patient preferences and perceptions,65 lifestyle choices,66 67 physician choices,68–71 environmental triggers,72–76 poverty,77 social disparities,78 and life events,79 smoking80 and the gut pathobiont81 all affect manifestations and outcomes in ways that dictate who participates in a study on SLE and in ways that cannot be examined in animal models 82. Stratification on gene expression , quantitative, predicts risk and possibly phenotype83–93; SLE-like illnesses (the autoinflammatory diseases),94 Aicardi-Goutières syndrome,95 96 Canale-Smith syndrome97 and SLE associated with immunodeficiency98 suggest mechanisms for primary illness, and for phenotype diversity.…”

Section: Stratificationmentioning

confidence: 99%