Background The U.S. Centers for Disease Control (CDC) reported significant differences by age and race in mortality rates (MRs) among SLE patients, 1979-1998 (1). MRs were highest among African Americans and patients > 45 years old (1), but MRs among U.S. SLE patients with have not been reported more recently. Medicaid is the U.S. federal-state jointly run program for providing medical insurance to low income individuals.
Objectives To examine MRs among SLE patients enrolled in Medicaid in the U.S. from 2000 to 2006
Methods From the Medicaid Analytic eXtract (MAX) data, containing all billing claims from 2000-2006, we identified patients aged 3-65 with prevalent SLE (≥ 3 SLE ICD-9 codes [710.0], >30 days apart), as well as those with lupus nephritis (defined with ≥ 2 additional ICD-9 codes for nephritis, renal insufficiency or renal failure). Demographic data included age, sex, race, ethnicity, and region of residence. MRs were calculated using annual deaths among individuals with SLE in each sociodemographic group in each year (deaths ± SD per 100,000 Medicaid patients with SLE). T-tests were used to compare differences among groups
Results We identified 43,351 patients with prevalent SLE. 40,417 (93%) were female, 39,283 (91%) were adults (≥ 18 at last follow-up) and 22% of SLE patients had lupus nephritis. Racial and ethnic breakdown was: African American (38%), White (37%), Hispanic (14%), Asian (4%), Native American (2%) and other (5%). 38% of patients lived in the South, 22% in the West, 21% in the Northeast and 19% in the Midwest. During the study period, the overall mean annual MR was 1,185 ± 387 deaths per 100,000. Annual MRs were higher among males than females (1,420 ± 416 vs. 951 ± 153 per 100,000; p=0.02), among those aged 45-64 compared to those aged 15-44 (1,462 ± 248 vs. 730 ± 146 per 100,000, p<0.0001) and higher among African Americans, Whites and Native Americans (compared to Hispanics and Asians, all p<0.05). Among women aged 45-65, MRs were 6.5 x higher in Native Americans (1,759 per 100,000) and 6.0 x higher in African Americans (1,686 per 100,000) than those among Asians (270 per 100,000).
Conclusions We found marked age, sex and race-specific differences in MRs among Medicaid patients with SLE. MRs among SLE patients were highest among African and Native Americans, men vs. women and patients over age 45.
Centers for Disease Control and Prevention (CDC) Trendsin Deaths from Systemic Lupus Erythematosus--United States, 1979-1998. MMWE Morb Mortal Wkly Rep 2002;5:371-4.
Disclosure of Interest None Declared