Incidence of systemic lupus erythematosus race and gender differences

Abstract

Objective. To examine racial differences in the incidence of systemic lupus erythematosus (SLE).Methods. A population-based registry of SLE patients in Allegheny County, Pennsylvania, was used to identify incident cases of SLE diagnosed between January 1, 1985 and December 31, 1990, from 3 sources, by medical record review (University of Pittsburgh Lupus Databank, rheumatologists, and hospitals). Capture recapture methods using log-linear models were used to estimate the level of case-finding and to calculate 95% confidence intervals (CI). Incidence rates were calculated per 100,000 population.Results. A total of 191 definite and 78 probable incident cases of SLE were identified, and the overall annual incidence rates were 2.4 (95% CI 2.1-2.8) and 1.0 (95% CI 0.8-1.3), respectively. The crude incidence rates of definite SLE were 0.4 for white males, 3.5 for white females, 0.7 for African-American males, and 9.2 for African-American females. The annual incidence rates of definite SLE remained fairly constant over the study interval. African-American females with definite SLE had a younger mean age at diagnosis compared with white females (P < 0.05). Since the overall ascertainment rate was high (85%; 95% CI 78-92%), the ascertainment-corrected incidence rate for definite SLE, 2.8 (95% CI 2.6-3.2), was similar to the crude rate.Conclusion. Our rates clearly confirm previous reports of an excess incidence of SLE among females compared with males and among African-Americans compared with whites. We have used capture-recapture methods to improve the accuracy of SLE incidence rates, and we advocate their use to facilitate comparisons across studies.Accurate determination of the incidence rates of systemic lupus erythematosus (SLE) is vital to understanding the clinical and societal consequences of this disease. Unfortunately, the available data concerning the incidence and prevalence of SLE are conflicting. A number of population-based studies have estimated the incidence of SLE in the United States, Europe, and the Caribbean (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). It is important to note that all these studies relied on reporting of cases through one or more sources of ascertainment rather than by population survey. Early epidemiologic investigations of SLE in the US provided important preliminary estimates of disease incidence and differences in incidence based on age, sex, and race (1,2,4). Although these studies indicated a predominance of SLE in women and an increased incidence in AfricanAmericans compared with whites, the reported rates within a given gender and within specific racial groups varied dramatically across geographic areas and over study periods within a geographic area.Recent European studies have included methodologic improvements (i.e., use of standardized case

Association between baseline levels of C-reactive protein (CRP) and a dinucleotide repeat polymorphism in the intron of the CRP gene

“…Our observation that African-Americans carry fewer CRP low alleles than Caucasians might initially seem at odds with this hypothesis, as African-Americans are known to have a disproportionately higher incidence of SLE. 41 However, if CRP contributes to the pathogenesis of SLE at all, it likely acts as a disease modifying factor rather than a disease risk factor. This could explain the preferential association of Fc␥RIIa alleles (a CRP receptor) with SLE in African-Americans.…”

An analysis of apoptosis in lymphoid organs and lupus disease in murine systemic lupus erythematosus (SLE)

“…In this study we have not reported on mitotic indices in the tissues under investigation, nor data on the recruitment/retention/ phenotype of lymphoid cells-this work is currently in progress. Lupus disease develops in nine times more women than men [29,30], and this trend is echoed in mice [31]. Sex hormones can substantially affect development of the disease in mouse, with androgens protecting males resulting in prevalence of the syndrome in females [23].…”

Focus on systemic lupus erythematosus in Indigenous Australians: towards a better understanding of autoimmune diseases

“…Compared with Caucasians, the prevalence of SLE is higher among North American Indians, African-Americans, African-Caribbeans, Hispanics and Asians. [8][9][10][11]19,[26][27][28][29][30] In IA, the reported prevalence of SLE varies from 52.6 to 92.8 per 100 000 people, a prevalence two to four times higher than that of Caucasians (Table 1). [12][13][14][15][16] In Far North Queensland, SLE prevalence in IA was 92.8 per 100 000 persons, twice that of the generally European descended population (45.3 per 100 000 persons).…”