Objectives To determine the trends in incidence, prevalence and mortality of systemic lupus erythematosus (SLE) in a US population over four decades.
Methods We identified all the patients with SLE in Olmsted County, Minnesota who fulfilled the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria for SLE during 1976–2018. Age-specific and sex-specific incidence and prevalence dates were adjusted to the standard 2000 projected US population. The EULAR/ACR score was used as a proxy for disease severity. Standardised mortality ratio (SMR) was estimated.
Results There were 188 incident SLE cases in 1976–2018 (mean age 46.3±SD 16.9; 83% women). Overall age-adjusted and sex-adjusted annual SLE incidence per 100 000 population was 4.77 (95% CI 4.09 to 5.46). Incidence was higher in women (7.58) than men (1.89). The incidence rate increased from 3.32 during 1976–1988 to 6.44 during 2009–2018. Incidence rates were higher among the racial and ethnic minority populations than non-Hispanic whites. The EULAR/ACR score did not change significantly over time. Overall prevalence increased from 30.6 in 1985 to 97.4 in 2015. During the study period, there was no improvement in SMR over time (p=0.31).
Conclusions The incidence and prevalence of SLE are increasing in this US population. The increase in incidence may be at least partially explained by the rising ethnic/racial diversity of the population. There was no evidence that the severity of SLE has changed over time. The survival gap between SLE and the general population remains unchanged. As the US population grows more diverse, we might continue to see an increase in the incidence of SLE.
- lupus erythematosus, systemic
- autoimmune diseases
Data availability statement
Data are available upon reasonable request.
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Handling editor Josef S Smolen
Contributors All authors were involved in drafting the article or revising it critically for important intellectual content and all authors approved the final version to be submitted for publication. AD-G and CSC had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. AD-G, CSC contributed to study conception and design. MH, MV-A, S-AO-O, JD, AS-R contributed to acquisition of data. AD-G, MH, SQD, REG, HL, GSA, CGH, CSC contributed to analysis and interpretation of data. AD-G and CSC are guarantors.
Funding The Lupus Midwest Network (LUMEN) project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) under Grant number U01 DP006491 as part of a financial assistance award totaling $1 750 000 with 100 per cent funded by CDC/HHS. The Rochester Epidemiology Project was supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. AD-G is supported by the Rheumatology Research Foundation Scientist Development Award and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
Competing interests MH is supported by the Rheumatology Research Foundation. CSC is supported by the National Institutes of Health.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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