Systemic lupus erythematosus epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
Epidemiology and Demographics
Prevalence
- Worldwide, the prevalence of systemic lupus erythematosus is 60 per 100,000 persons.
- Worldwide, a conservative estimate states that over 5 million people have lupus.
- In United States, the prevalence of systemic lupus erythematosus ranges from a low of 20 per 100,000 persons to a high of 150 per 100,000 persons with an average prevalence of 25 per 100,000 persons.
Incidence
- In North America, South America, Europe, and Asia, the incidence of systemic lupus erythematosus ranges from a low of 1 per 100,000 persons to a high of 20 per 100,000 persons with an average prevalence of 12 per 100,000 persons.
Case Fatality Rate
- Causes of premature death associated with SLE are mainly active disease, organ failure (e.g., kidneys), infection, or cardiovascular disease from accelerated atherosclerosis.8 In a large international SLE cohort with average follow-up of over 8 years during a 1958–2001 observation interval, observed deaths were much higher than expected for all causes, and in particular for circulatory disease, infections, renal disease, and some cancers. Those who were female, younger, and had SLE of short duration were at higher risk of SLE-associated mortality.9 Using death certificates for US residents, SLE was identified as the underlying cause of death for an average of 1,034 deaths from 2010–2014. SLE was identified as a contributing cause of death (one of multiple causes of death, including underlying cause of death) for an average of 1,803 deaths during that 4-year-period.10 During 1979--1998, the annual number of deaths increased from 879 to 1,406, and the crude death rate increased from 39 to 52 per 10 million population, with 22,861 deaths reported during the study period
- Of all SLE deaths, 36.4% occurred among persons aged 15--44 years. For each year, crude death rates increased with age, were >5 times higher among women than men, and were >3 times higher among blacks than whites. Among black women, death rates were highest and increased most (69.7%) among those aged 45--64 years, with little difference in rates among other age groups JJ Sacks, MD, CG Helmick, MD, G Langmaid, JE Sniezek, MD, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
Age
- The prevalence of the disease is common in the young patient population even though it can occur at any age.
- Sixty-five percent of patients with SLE have disease onset between the ages of 16 and 55
Gender
Women are more commonly affected with systemic lupus erythematosus than men. Systemic lupus erythematosus flare ups are more prevalent in women.
The female to male ratio is approximately 5 to 1.
Race
Systemic lupus erythematosus is more prevalent in the African race and Asian races.
The disease appears to be more common in urban than rural areas.
- SLE occurs with much greater severity among African-American women, who suffer more severe symptoms as well as a higher mortality rate. [1]
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SLE is one of the more fatal forms of rheumatic diseases and non-Causcasian race is a risk factor for death from SLE
The findings in this report document marked age-, sex-, and race-specific disparities in SLE deaths. Although SLE mortality is most frequently caused by active SLE or by associated organ failure, infection, or cardiovascular disease from accelerated atherosclerosis (3), some studies suggest that renal disease might account for excess SLE deaths among blacks (4). Differential ascertainment and reporting of SLE deaths by race is possible, but probably does not account for the magnitude of observed differences, especially among different age groups for white and black women.
SLE accounts for 14.5% of all deaths from arthritis (CDC, unpublished data, 1997) and represents one of these conditions that has premature mortality; approximately one third of deaths from SLE occur among persons aged <45 years. Of all deaths from arthritis, SLE accounts for 44.0% of deaths among persons aged <45 years (CDC, unpublished data, 1997).
Older national prevalence estimates vary widely due to differences in case definitions, small study populations, and study methods. A conservative estimate suggests a prevalence of 161,000 with definite SLE and 322,000 with definite or probable SLE.4