Changes in Proportionate Mortality Patterns in Patients With Systemic Lupus Erythematosus in the United States From 1999 to 2020.

Abstract

To determine proportionate mortality (PM) patterns in patients with systemic lupus erythematosus (SLE) in the last 2 decades in the United States. This retrospective cohort study used multiple causes of death files from the Centers for Disease Control and Prevention database to analyze the trends of PM rates in SLE between 1999 and 2020. We specifically determined PM for various underlying causes of death in SLE and the general population (GP). We investigated trends over time for PM in SLE and the general US population. During the study period, the PM for both cardiovascular disease, ischemic heart disease, and cerebrovascular disease significantly decreased in the GP, whereas it remained stable in the SLE group except for a significant decline in ischemic heart disease PM between 1999 and 2004. Proportionate mortality for hypertensive heart disease, diabetes mellitus/obesity, respiratory diseases, and nervous system diseases increased significantly in both SLE and GP. In contrast, PM for malignant neoplasms (MNs) and hematologic malignancies (HMNs) increased significantly in the SLE population, whereas it decreased in the GP. Pairwise trend analysis further demonstrated that trends in PM for MN and HMN were significantly different between the SLE and GP populations. In the last 2 decades, PM trends of SLE followed different paths compared with the GP. Cardiovascular disease and cerebrovascular disease PM remained stable in SLE while it decreased in the GP. In contrast to the GP, PM of MN and HMN increased in SLE.