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Declining in-hospital mortality gap between systemic lupus erythematosus (SLE) and non-SLE hospitalisations: a national study
  1. Jasvinder A Singh1,2,
  2. John D Cleveland3
  1. 1Department of Medicine and Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
  3. 3Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Jasvinder A Singh, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;{at}

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Mortality in systemic lupus erythematosus (SLE) is twofold to threefold higher compared with the general population.1 Overall SLE mortality decreased over time,1 2 but in-hospital mortality has increased.3 We hypothesised an increase in in-hospital mortality rates in SLE and SLE–non-SLE mortality gap over time.

We included discharges from US National Inpatient Sample (NIS) from 1998 to 2014, the last year of the use of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The NIS is a 20% stratified sample of hospital discharges. We identified primary SLE hospitalisations based on the presence of an ICD-9-CM code of 710.0x in the primary position; this diagnostic code has a sensitivity of 98% and specificity of 72%.4

We calculated the unadjusted, age-adjusted and age–sex-adjusted in-hospital mortality rates per 1000 primary SLE hospitalisations versus general non-SLE hospitalisations. We used the Cochran Armitage test to analyse mortality time trends.

The 241 130 primary SLE hospitalisations in 1998–2014 included predominantly black (34.3%), young (mean age, 36 years) and female (86.9%) patients. Deyo-Charlson Comorbidity Score was ≥2 for 47%; one-third were receiving Medicaid and 1.5% died in-hospital (table 1).

View this table:
Table 1

Characteristics of hospitalisations in people with SLE in the USA from 1998 to 2014*

Unadjusted mortality in primary SLE hospitalisations wavered over time and decreased significantly from 17.9 per 1000 in 1998 to 9.5 in 2014, versus 28.1 per 1000 to 21.2 in non-SLE (45.2% vs 25.9% reduction; p<0.01 for both; figure 1); SLE hospitalisations occured in much younger people than non-SLE hospitalisations. Age, sex, race/ethnicity did not change over time, …

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  • Handling editor Josef S Smolen

  • Presented at An abstract from this work has been accepted for presentation at the American College of Rheumatology Convergence 2020 meeting (

  • Contributors JAS: Study conception and design, development of study protocol, review of statistical analyses, writing the first draft of the manuscript, critical revisions and submission of the manuscript and approval of the final manuscript version. JC: Data programming and quality monitoring, performance of statistical analyses, critical revisions and approval of the final manuscript version.

  • Funding This material is the result of work supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Centre, Birmingham, Alabama, USA.

  • Disclaimer The funding body did not play any role in design, in the collection, analysis and interpretation of data; in the writing of the manuscript and in the decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

  • Competing interests JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM, Trio Health, Medscape, WebMD, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, Practice Point Communications, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Vaxart Pharmaceuticals and Charlotte’s Web Holdings. JAS previously owned stock options in Amarin, Viking and Moderna Pharmaceuticals. JAS is on the speaker’s bureau of Simply Speaking. JAS is a member of the executive of OMERACT, an organisation that develops outcome measures in rheumatology and receives arms-length funding from 12 companies. JAS serves on the Food and Drug Administration Arthritis Advisory Committee. JAS is the chair of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. JAS previously served as a member of the following committees: member, the ACR Annual Meeting Planning Committee and Quality of Care Committees, the Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee and the co-chair of the ACR Criteria and Response Criteria subcommittee.

  • Patient consent for publication Not required.

  • Ethics approval The University of Alabama at Birmingham’s Institutional Review Board approved this study and waived the need for informed consent for this database study. All investigations were conducted in conformity with ethical principles of research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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