Geographical variation in mortality from systemic lupus erythematosus in the United States

Abstract

The aim was to identify demographic and environmental factors that affect the incidence and course of systemic lupus erythematosus (SLE) by studying geographical variation in mortality from the disease. Counts of SLE deaths during a 10-y period were determined for each of the 3111 counties in the United States. The counts were subjected to statistical techniques for detecting spatial clusters with significantly higher or lower mortality than expected. Census data were used to compare attributes of the resulting clusters. Four clusters with significantly elevated SLE mortality were identified. They were centered in Alabama, Arkansas, Louisiana and New Mexico and had 41-65% more SLE deaths than expected. Four other clusters with significantly low mortality were centered in Minnesota, Vermont, Virginia and Washington and had 32-44% fewer deaths than expected. Comparison of SLE mortality rates between the New Mexico and Vermont clusters yielded relative risks of 3.2, 3.4 and 5.9 for white, black and other race women, respectively, and of 2.1, 5.2 and 'undefined' for white, black and other race men. Census data showed that the clusters with elevated mortality had higher poverty rates and/or greater concentrations of ethnic Hispanics than those with lower mortality. SLE mortality rates show great regional variation within the United States. The variation appears to reflect, in part, geographical patterns in socioeconomic status and in the distribution of persons of Hispanic origin.

Intravenous cyclophosphamide-resistant systemic lupus erythematosus in Arizona

“…All but 2 of our patients were Hispanic, and 1 of the 2 was Native American. The outcome in lupus also varies by geographical region [32,33]. However, it is almost impossible to differentiate the relative role of each factor (ethnicity, geography) within these studies.…”

“…However, it is almost impossible to differentiate the relative role of each factor (ethnicity, geography) within these studies. Adult studies have indicated increased SLE mortality in areas with high concentrations of Hispanic patients, such as New Mexico [33]. However, some authors have attributed these findings to the poorer socioeconomic conditions and lack of health insurance among Hispanic populations, which may indicate a lack of adequate health care [33].…”

Neuropsychiatric involvement in systemic lupus erythematosus

“…Several factors appear to contribute to this trend, including genetic (ie, racial) and sociodemographic factors (ie, education, income, insurance status, smoking, treatment adherence, abnormal attitudes toward illness) and comorbidities (ie, hypertension). The mechanisms through which these factors may affect the clinical expression of SLE in these three US ethnic groups have received increased attention in recent publications [12][13][14][15].…”

From Markers to Molecular Mechanisms: Type 1 Diabetes in the Post-GWAS Era

“…Epidemiological approaches have identified multiple associated environmental factors that are neither homogenously distributed in populations, nor corrected for in heritability estimates, such as socioeconomic status, urban/rural location [123][124][125][126], and dietary habits [127][128]. For some diseases, it is possible to estimate the contribution of such factors by comparing disease prevalence in monozygotic twins raised together with that of those raised separately.…”