Racial and Ethnic Differences in the Prevalence and Time to Onset of Manifestations of Systemic Lupus Erythematosus: The California Lupus Surveillance Project

Abstract

Objective. The California Lupus Surveillance Project (CLSP) is a population-based registry of individuals with systemic lupus erythematosus (SLE) residing in San Francisco County, California from 2007 to 2009, with a special focus on Asian/Pacific Islander and Hispanic patients. We used retrospective CLSP data to analyze racial and ethnic differences in lupus manifestations and in the timing and risk of developing severe manifestations.Methods. A total of 724 patients with SLE were retrospectively identified. Prevalence ratios (PRs) of SLE manifestations were calculated using Poisson regression models stratified by race/ethnicity and adjusted for sex, age at SLE diagnosis, and disease duration. We studied onset of severe SLE manifestations after SLE diagnosis using Kaplan-Meier methods to examine time-to-event and Cox proportional hazards regression models to estimate hazard ratios (HRs). White patients were the referent group in all analyses.Results. African Americans, Asian/Pacific Islanders, and Hispanic patients had increased prevalence of renal manifestations (PR 1.74 [95% confidence interval (95% CI) 1.40-2.16], PR 1.68 [95% CI 1.38-2.05], and PR 1.35 [95% CI 1.05-1.74], respectively). Furthermore, African Americans had increased prevalence of neurologic manifestations (PR 1.49 [95% CI 1.12-1.98]), and both African Americans (PR 1.09 [95% CI 1.04-1.15]) and Asian/Pacific Islanders (PR 1.07 [95% CI 1.01-1.13]) had increased prevalence of hematologic manifestations. African Americans, Asian/ Pacific Islanders, and Hispanic patients, respectively, had higher risk of developing lupus nephritis (HR 2.4 [95% CI 1.6-3.8], HR 4.3 [95% CI 2.9-6.4], and HR 2.3 [95% CI 1.4-3.8]) and thrombocytopenia (HR 2.3 [95% CI 1.1-4.4], HR 2.3 [95% CI 1.3-4.2], and HR 2.2 [95% CI 1.1-4.7]). Asian/Pacific Islander and Hispanic patients had higher risk of developing antiphospholipid syndrome (HR 2.5 [95% CI 1.4-4.4] and HR 2.6 [95% CI 1.3-5.1], respectively).Conclusion. This is the first epidemiologic study comparing lupus manifestations among 4 major racial and ethnic groups. We found substantial differences in the prevalence of several clinical SLE manifestations among racial/ethnic groups and discovered that African Americans, Asian/Pacific Islanders, and Hispanic patients are at increased risk of developing several severe manifestations following a diagnosis of SLE.

Anti-Müllerian hormone in African-American women with systemic lupus erythematosus

“… 13 In the USA, African-American women are at 3 times the risk of SLE compared with white women and also tend to experience more severe SLE, potentially causing greater ovarian toxicity. 19–21 Thus, the relationship between SLE and ovarian reserve as measured by AMH may differ among African-American women.…”

Clinical characterization, outcomes, and prognosis in patients with systemic lupus erythematosus admitted to the intensive care unit

“…9 Indeed, racial and ethnic differences have recently been analyzed by the California Lupus Surveillance Project, and it was found that Hispanic patients showed an increased risk of developing severe manifestations such as LN, thrombocytopenia, and APS earlier than Caucasian patients following an SLE diagnosis. 23 The main complication of SLE at admission was LN, with a considerable percentage of patients requiring renal replacement therapy. A study by Diaz-Coronado et al.…”

Update on lupus epidemiology: advancing health disparities research through the study of minority populations

“…Racial and ethnic differences were recently analyzed in lupus manifestations and in the timing and risk of developing severe manifestations in the California Lupus Surveillance Project (CLSP) [9 ▪ ]. This was the first epidemiologic study of lupus comparing manifestations among the four-major racial/ethnic groups in the United States: blacks, whites, Asian/Pacific Islanders (APIs), and Hispanics.…”

“…A consistent finding of epidemiological studies is the higher incidence of lupus nephritis and end-stage renal disease in Blacks and Hispanics with SLE [1,9 ▪ ,28,37,38]. A US group analyzed records in the United Network for Organ Sharing program and Standard Transplant Analysis and Research files to compare kidney allograft survival in African-American and Hispanic individuals who had SLE and received kidney transplants between 1987 and 2006 [39].…”