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.

Perspectives

I hope this article makes people appreciate the progress made in the recognition of higher early mortality risk in lupus and improving the treatment of hospitalized lupus patients over time. However, adjusted mortality reduction was far lower in no-Whites vs. Whites with lupus, consistent with persistent race/ethnicity disparities in lupus. We need to address these disparities in lupus mortality going forward.

Dr. Jasvinder A. Singh
University of Alabama at Birmingham

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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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