Asian patients hospitalized with lupus at 79% higher mortality risk than whites
Despite advances in care, Asian patients hospitalized for systemic lupus erythematosus are at a 79% greater risk for death than white patients hospitalized with the same disease, according to data published in Arthritis Care & Research.
“Advances in therapy in recent decades have altered rates of damage accrual, hospitalizations, and mortality for patients with SLE, but recent studies evaluating SLE in-hospital mortality are limited,” Christine Anastasiou, MD, of the University of California San Francisco, told Healio Rheumatology. “The most recent multi-year national evaluation of mortality for U.S. community hospitalized SLE patients is from data spanning 1998 to 2002.”
“Many other studies evaluating SLE mortality have been based on patient cohorts which may not represent the general SLE population and capture a relatively small number of total deaths,” she added. “... This is also, to our knowledge, the first large-scale population-based study in over 20 years to evaluate U.S. Asian/Pacific Islander in-hospital mortality among individuals with SLE.”
To analyze mortality time trends among adults hospitalized for SLE, compared with the general hospitalized population, as well as factors associated with an increased risk for death, Anastasiou and colleagues studied data from the National Inpatient Sample. Focusing on the years between 2006 and 2016, the researchers analyzed a total of 340,467,049 hospitalizations, including 1,903,279 patients with a discharge diagnosis of SLE.
The researchers used this data to estimate all-cause mortality for adults discharged from community hospitals across the United States. In addition, they used Poisson regression models to estimate the risk for inhospital death for all patients. Covariates included demographics, socioeconomic factors, comorbidity score, hospital region, SLE diagnosis and race or ethnicity.
According to the researchers’ adjusted analysis, the overall risk for death among patients hospitalized with SLE decreased between 2006 and 2008, from 2.2% to 1.5% (P < .001). Following 2008, mortality plateaued at a rate that was statistically similar to the general hospitalized population.
However, despite this improvement in overall mortality, the researchers found that Asian patients hospitalized with SLE had a 43% higher risk for death compared with those without SLE (P < .001), and a 79% higher risk for death compared with white patients hospitalized with SLE (P < .001). In addition, hospitalizations among Black and Hispanic patients with SLE were more likely to end in death than hospitalizations for people of the same racial or ethnic group without SLE (P < .001). They were also more likely to end in death than hospitalizations for white patients with SLE (P < .001).
Meanwhile, hospitalizations among white patients with SLE were less likely to end in death compared with those without SLE (P < .001).
According to the researchers, Asian or Pacific Islander patients hospitalized with SLE demonstrated a 1.65 times higher risk for death compared with white patients (95% CI, 1.42-1.92).
In addition, SLE hospitalizations not covered by insurance were associated with a higher risk for death (RR = 1.36; 95% CI, 1.18-1.57), compared with those covered by Medicare. Older patients, men and those with a higher comorbidity index score also had a higher risk for death during hospitalization.
“Our study results show that the risk of death for admitted patients with SLE has decreased since 2006 with rates now similar to other hospitalized patients,” Anastasiou said. “Despite advances in overall all-cause mortality among all patients with SLE, hospitalized ethnic and racial minorities including Asians/Pacific Islanders, Hispanics and Blacks have a higher risk of inpatient death compared to both patients of the same racial/ethnic group without SLE and to whites.”
She added: “While improvements in mortality in SLE is good news, these data also suggest the need to increase efforts to eliminate racial/ethnic disparities in outcomes through more aggressive early recognition, treatment and long-term management of the disease.”