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, a conservative estimate states that over 5 million people have lupus.
- In the United States the prevalence of the disease is 25 per every 100,000. In the United States alone, it is estimated that between 270,000 and 1.5 million people have lupus, making it more common than cystic fibrosis or cerebral palsy.
Age
- The prevalence of the disease is common in the young patient population even though it can occur at any age.
Gender
Annual incidence estimates were much higher for women than men in Michigan (9.3 vs 1.5 per 100,000),5 Georgia (10.6 vs 1.9 per 100,000)6 and the American Indian/Alaska Native population (unadjusted 8.4 vs 2.7 per 100,000)
- Lupus occurs in both men and women but young women of the childbearing age are nine times more often diagnosed than men.
Race
- The disease appears to be more prevalent in women of African, Asian, Hispanic and Native American origin but this may be due to socioeconomic factors.
- 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
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.
There are no recent studies to determine if SLE prevalence or incidence are changing over time.
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
Results from the CDC Lupus registries estimated annual prevalence from 2002–2004 was much higher for blacks than whites in Michigan (Washtenaw and Wayne Counties) (111.6 vs 47.5 per 100,000 people)5 and in Georgia (DeKalb and Fulton Counties) (128.0 vs 39.9 per100,000 people).6 Annual prevalence from 2007–2009 for American Indians/Alaska Natives was 178 per 100,000.7 New registries in California (San Francisco County) and New York City (Manhattan) will soon provide annual prevalence estimates for Hispanics and Asians.
Annual prevalence estimates were much higher among women than men in Michigan (9.3 vs 1.5 per 100,000 people),5 in Georgia (145.8 vs 17.5 per 100,000 people),6 and in the American Indian/Alaska Native population (271 vs 54 per 100,000 people).7
SLE Incidence
Recent national incidence estimates are not available for SLE. National incidence data are difficult to obtain because it is relatively expensive to capture all diagnosed cases reliably (learn more about SLE Prevalence and Incidence) and the year of onset is hard to determine (slowly developing, non-specific symptoms and signs), so resource-intense studies must be done in small areas.1
SLE incidence estimates are available from the various CDC-funded lupus registries. Annual incidence for different racial/ethnic groups from 2002–2004 was much higher for blacks than whites in Michigan (7.9 vs 3.7 100,000 people)5 and in Georgia (9.4 vs 3.2 per 100,000 people).6 Annual incidence from 2007–2009 for American Indians/Alaska Natives was 7.4 per 100,000)7 New registries have begun in California (San Francisco County) and New York City (Manhattan), and will soon provide annual incidence estimates for Hispanics and Asians.
Mortality
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