Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000–2004

Abstract

Objective Systemic lupus erythematosus (SLE) and lupus nephritis (LN) disproportionately affect racial/ethnic minorities and lower socioeconomic status (SES) individuals. We investigated the epidemiology and sociodemographics of SLE and LN in the low-income U.S. Medicaid population. Methods We utilized Medicaid Analytic eXtract data, with billing claims from 47 states and Washington, D.C. for 23.9 million individuals, aged 18–65 years, enrolled in Medicaid for >3 months, 2000–2004. Individuals with SLE (> 3 visits, ICD-9 code 710.0, >30 days apart) and with LN (>2 ICD-9 codes for glomerulonephritis, proteinuria or renal failure) were identified. We calculated SLE and LN prevalence and incidence, stratified by sociodemographic categories, and adjusted for number of American College of Rheumatology (ACR) member rheumatologists and SES using a validated composite of U.S. Census variables. Results We identified 34,339 individuals with SLE (prevalence = 143.7/100,000) and 7,388 (21.5%) with LN (prevalence = 30.9/100,000). SLE prevalence was 6 times higher among women, nearly double in African American compared to White women, and highest in the U.S. South. LN prevalence was higher among all racial/ethnic groups compared to Whites. The lowest SES areas had the highest prevalence; areas with the fewest ACR rheumatologists had the lowest. SLE incidence was 23.2/100,000 person-years, and LN incidence was 6.9/100,000 person-years, with similar sociodemographic trends. Conclusions In this nationwide Medicaid population, there was sociodemographic variation in SLE and LN prevalence and incidence. Understanding the increased burden of SLE and its complications in this low-income population has implications for resource allocation and access to subspecialty care.

Systemic lupus erythematosus: An update for ophthalmologists

“…This study found an unusually high prevalence and incidence that is likely to reflect the nature of the inclusion criteria (i.e. limited to Medicaid users) and is discussed later in this review in the context of the influence of social deprivation 28 .In contrast two state-based studies, the Georgia Lupus Registry 72 and the Michigan Lupus Epidemiology and Surveillance Program 127 , identified potential cases from a wider range of sources, albeit over narrower geographical areas. The overall age-adjusted incidence rate was 5.6 per 100,000 per year for the Georgia Lupus Registry and 5.5 per 100,000 per year for the Michigan study, with an ageadjusted prevalence rate of 73 per 10, 000 reported for both studies.…”

Update on Lupus Nephritis

“…The prevalence of SLE and the chances of developing lupus nephritis (LN) vary considerably between different regions of the world and different races and ethnicities (Table 1) (2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In the United States, the higher frequency of LN in black populations persists after adjustment for socioeconomic factors (15). Additionally, black and Hispanic SLE patients develop LN earlier (16), and have worse outcomes than white patients with SLE, including death and ESRD (10).…”

Chronic Diarrhea Unmasking Systemic Lupus Erythematosus

“…Age of presentation is typically around the third decade, more likely in females of African, Hispanic, and Asian origin [1]. The most common initial symptoms include fever, arthralgia, and malar rash.…”