Systemic lupus erythematosus in three ethnic groups. VIII. Predictors of early mortality in the LUMINA cohort

Abstract

Objective To determine the features associated with mortality in a multiethnic US cohort of patients with systemic lupus erythematosus (SLE) within 5 years of study onset. Methods Socioeconomic and demographic features (age, gender, ethnicity, marital status, education, occupation, poverty, and health‐related behaviors [drinking, smoking, exercising]), clinical and immunologic features (disease duration, disease onset type, disease activity according to the Systemic Lupus Activity Measure [SLAM], disease damage according to the Systemic Lupus International Collaborating Clinics [SLICC] Damage Index [SDI], number of American College of Rheumatology criteria at diagnosis, organ system manifestations, fatigue and pain ratings, and medication usage and autoantibodies), immunogenetic features (HLA class II genotypes), and behavioral and psychosocial features (social support, illness‐related behaviors, and helplessness), as obtained at enrollment into the study, were compared between survivors and deceased patients. Logistic regression analysis was used to determine significant independent risk factors for mortality. Results Within 5 years of study onset, 34 of 288 patients have died. Fourteen deaths could be directly attributed to SLE and 11 to infections. In 1 patient the cause of death could not be determined. In the remaining 8 patients the cause of death was neither infectious nor disease‐related. There were 10 deaths among Hispanics, 18 among African Americans, and 6 among Caucasians (P< 0.05). Variables associated with mortality in the univariable analyses included poverty, less than full‐time employment, difficulty in accessing health care, shorter disease duration, cardiovascular and renal involvement, higher serum creatinine levels and lower hematocrit values, higher SLAM and SDI scores, lower use of antimalarial drugs, and higher use of (some) immunosuppressants. Specific autoantibodies and class II HLA genotypes were not associated with mortality. Poverty and higher baseline SLAM and SDI scores were independently associated with mortality in the multivariable analyses. Conclusions Disease activity, disease damage, and poverty appear to be the most important determinants of mortality in this multiethnic US cohort of SLE patients. These results have applicability to the management of patients with SLE, a disease that more severely affects disadvantaged minority population groups.

Clinical Composite Measures of Disease Activity and Damage Used to Evaluate Patients With Systemic Lupus Erythematosus: A Systematic Literature Review

“…52 The concept of damage in SLE has become an important outcome measure, as it not only predicts mortality also functional capacity and health resource utilization. [53][54][55] In this review, three measures of injury have been identified, one that is completed by the doctor, the SDI, and 2 to be completed by the patient LDIQ and BILD. The 2 self-administered measures of damage showed a good correlation with the extent to which the physician measured was considered the gold standard.…”

Excess weight and associated risk factors in patients with systemic lupus erythematosus

“…On the other hand, in the multivariate analysis, interestingly, the occupation variable presented a tendency to associate with a higher frequency of excess weight (p = 0.055). Few studies have evaluated this variable when describing socio-demographic characteristics, [25].…”

The GLADEL Multinational Latin American Prospective Inception Cohort of 1,214 Patients With Systemic Lupus Erythematosus

“…Important differences were detected in clinical and immunogenetic variables that could help identify associations with clinical manifestations, disease activity, and physician's global scores. The epidemiology of SLE has been evaluated mainly in North America [2][3][4][5][6][7][8][9][10][11]21,27,29,48,[54][55][56]64,76,77,81,84 and in some European countries 17,19,20,[38][39][40]42,46 , but little information is available from Latin America 1,16,22,23,26,36,37,41,47,49,51,52,65,79 . For obvious reasons, the Latin American studies make few comparisons between ethnic groups, although some have shown a poor prognosis and a high prevalence of infections in African-Latin American (ALA) SLE patients, both of which may relate to socioeconomic variables.…”

“…The LUMINA study has compared clinical, socioeconomic status, and disease-related variables in 3 ethnic groups in clinical centers in the United States [4][5][6][7][8]10,11,15,27,64,84 . Important differences were detected in clinical and immunogenetic variables that could help identify associations with clinical manifestations, disease activity, and physician's global scores.…”

“…Several studies from the United States have included Latin American patients, usually referring to them as ''Hispanics'' [5][6][7][9][10][11]27,39,60,64,81,84 , a term that is mainly derived from their language rather than their ethnic background, which can vary between and within Latin American countries. Notwithstanding, the so-called Hispanics in the United States have been shown to have more severe disease and poorer outcomes than whites, often equating African Americans, whose lupus tends to have poor prognosis 11,64 .…”