sus (SLE) was carried out at 9 university centers diverse in geographic, socioeconomic, and racial characteristics. The mortality and disease characteristics of the patients at study entry varied widely among centers. The survival rates from the time patients with a diagnosis of SLE were first evaluated at the participating center was 90% at 1 year, 77% at 5 years, and 71% at 10 years. Patients with a serum creatinine >3 mg/dl at study entry had the lowest survival rates: 48%, 29%, and 12% at 1, 5, and 10 years, respectively. Survival rate also correlated independently with the entry hematocrit, degree of proteinuria, number of preliminary American Rheumatism Association criteria for SLE satisfied, and source of funding of medical care. When data were corrected for socioeconomic status, race1 ethnic origin did not significantly influence survival. Survival rates varied widely at different participating institutions, generally due to differences in disease severity. Place of treatment was independently associated with survival only in the second year after study entry. Disease duration before study entry did not account for the differences in disease severity.Reports of prognosis in systemic lupus erythematosus (SLE) from single medical centers are often not comparable because of differences in the characteristics of patient populations. Because of these differences, there has been disagreement about the natural history and clinical course of SLE. Attempts to analyze literature trends (1) and to pool data from several centers (2) have provided some insights. In order to test the reliability of these insights and to assess more accurately which factors determine sur-60 1

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Causes of death were examined for 1,103 systemic lupus erythematosus patients who were followed from 1965 to 1978 at 9 centers that participated in the Lupus Survival Study Group. A total of 222 patients (20%) died. Lupus-related organ system involvement (mainly active nephritis) and infection were the most frequent primary causes of death. Causes of death were similar throughout the followup period. Hemodialysis had little impact on the length of survival for patients with nephritis. Active central nervous system disease and myocardial infarction were infrequent causes of death. There were no deaths from malignancy.Despite a linear improvement in survival rates since the turn of the century (l), mortality in systemic lupus erythematosus (SLE) is still appreciable. In 1964, Kellum and Haserick (2) EUGENE V. BARNETT(3) noted 54 (36%) deaths in 150 patients who were followed prospectively for an 8-year period. Dubois et a1 (4) in 1974 reported 249 (51%) deaths among 491 patients who were followed for 13 years. Renal disease was the most common cause of death in the latter two series. Mortality rates and causes of death reflect in part the nature of each center's patient population. In order to more accurately describe the causes of death among SLE patients treated at university-affiliated centers in the United States, we have studied the causes of death in more than 4,000 patient-years of followup of 1,103 patients with SLE who were seen by members of the Lupus Survival Study Group (5).

The purpose of this study was to predict post-settlement pain intensity, psychological distress, disability, and financial struggle among African American (n=580) and non-Hispanic Caucasian (n=892) Workers' Compensation claimants with single incident low back injury. The study was a population-based telephone survey conducted in three population centers in Missouri. Post-settlement outcomes were predicted from claimant demographics (race, age, gender); socioeconomic status (SES); diagnosis and legal representation; and Workers' Compensation resolution variables (treatment costs, temporary disability status, disability rating, settlement costs). Simultaneous-entry, hierarchical multiple linear regression analyses indicated that African American race and lower SES predicted higher levels of post-settlement pain intensity, psychological distress (general mental health, pain-related catastrophizing), disability (pain-related role interference), and financial struggle, independent of age, gender, diagnosis, legal representation, and Workers' Compensation resolution variables. The results suggest that African American race and lower SES-relative to Caucasian race and higher SES-are risk factors for poor outcomes after occupational low back injury. Mechanisms to explain these associations are discussed, including patient-level, provider-level, legal, and Workers' Compensation system-level factors.

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The recurrence of low back pain is common. Severe disability is rare. Patients who had sought care from chiropractors are more likely to return for recurrences than patients who had initially sought care from MDs.

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