Highlights
- •SLE mortality rate in 2012–2020 was 18.6 (95% CI, 17.0-20.2) per 1000 patient-years.
- •SLE standardized mortality ratio is 2.6 folds higher compared to the general population.
- •Cardiovascular diseases and cancer are the leading causes of death in SLE patients.
- •Despite amelioration in its management, SLE still represents a major cause of death.
- •Nowadays infections seem to be responsible for a low proportion of deaths in SLE patients.
Abstract
Objective
To assess mortality rates (MRs), standardized mortality ratios, and causes of death
in systemic lupus erythematosus (SLE) in a population-based study.
Methods
We analyzed linked administrative health databases of the Veneto Region (Italy, 4,900,000
residents). SLE was defined by any hospital diagnosis or healthcare copayment exemption
for SLE. We analyzed mortality from January 1st, 2012, until December 31st, 2021.
MRs per 1000 were stratified by year, sex, and age group. Standardized mortality ratios
were derived by comparing MRs of the general regional population. Causes of death
were coded using the ICD-10 coding system and they were grouped in: SLE, infectious
diseases, cardiovascular diseases (CVD), cancer, or others.
Results
Among 4283 SLE prevalent cases, 603 deaths occurred, corresponding to an average annual
standardized MR of 18.6 per 1000 person/year (95% CI 17.0-20.2). Out of 1092 incident
SLE patients, 90 died with a peak in the first year after diagnosis (MR 26.5 per 10,000
person/month). Standardized mortality ratio was 2.65 (95% CI 2.13-3.26) overall, and
highest among younger patients (<45 years: 5.59, 95% CI 2.05-12.4). Five- and 8-year
survival were 91% and 89%, respectively. About half of the deaths had CVD or cancer
as underlying cause, whereas infections were less frequently reported.
Conclusions
Although the medium-term survival since diagnosis is good, SLE mortality is still
higher than that of the general population, especially in youngest patients. Nowadays,
CVD seems to be the major cause of deaths in SLE, whereas infections account for a
low proportion of deaths, at least in Western countries.
Keywords
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Article info
Publication history
Published online: February 09, 2023
Accepted:
February 4,
2023
Received in revised form:
February 2,
2023
Received:
January 5,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
