What is it about?
Our objective was to assess the time-trends in in-hospital mortality rates in people with SLE hospitalized in the U.S. from 1998 to 2014, and compare it to people without SLE. We hypothesized an increase in in-hospital mortality rates in SLE and SLE-non-SLE mortality gap over time. The 241,130 primary SLE hospitalizations in 1998-2014 included predominantly black (34.3%), young (45% were 20-39 years; mean age, 36 years) and female (86.9%) patients. Unadjusted mortality in primary SLE hospitalizations decreased significantly, 45.2% from 17.9 per 1,000 in 1998 to 9.5 in 2014, versus a 25.9% reduction in non-SLE (28.1 per 1,000 to 21.2; p<0.01 for both). Age and sex-adjusted mortality gap by SLE also decreased: primary SLE hospitalization, 17.6 per 1,000 in 1998 to 13.8 in 2014 (21.5% reduction), versus 15.1 per 1,000 in 1998 to 13.2 in 2014 in non-SLE (12.5% reduction; p<0.01 for both). Age-sex-adjusted in-hospital mortality reduction over time in SLE was 24%for Whites vs. 3% in non-Whites, indicating a disparity in mortality reduction by race/ethnicity.
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Why is it important?
Systemic Lupus Erythematosus (SLE), commonly called lupus, is a serious, multi-system autoimmune disease that affects young people. Mortality in lupus is 2-3 fold higher compared to the general population. Time-trends showed a reduction in mortality in a multicentric SLE cohort from 1970 to 2001 and in a U.S. population-based SLE cohort from 1950 to 1992. In contrast, in a study using the U.S. National center for Health Statistics and National Inpatient Sample (NIS) data, in-hospital mortality was 2.9% and it increased from 1978 to 1998. Given these contradictory time-trends in overall versus in-hospital mortality and the lack of contemporary data in SLE, a contemporary study of mortality in lupus is needed. Our study shows declining lupus to non-lupus in-hospital mortality gap in the US over 17 years from 1998 to 2014. This is an important finding.
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This page is a summary of: Declining in-hospital mortality gap between systemic lupus erythematosus (SLE) and non-SLE hospitalisations: a national study, Annals of the Rheumatic Diseases, November 2020, BMJ, DOI: 10.1136/annrheumdis-2020-218386.
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