Temporal Trends and Demographic Insights Into Mortality From Systemic Lupus Erythematosus, 1999-2020.

Objective: Previous studies showed a decline in systemic lupus erythematosus (SLE) mortality rates from 1968 to 2013, yet mortality rates remained high relative to non-SLE mortality rates, with notable disparities. We aimed to delineate demographic characteristics associated with SLE deaths and map out the national and geographic trends of the last two decades.

Methods: We analyzed SLE deaths data from 1999 to 2020 using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research Multiple Cause of Death database. Age-adjusted mortality rates (AAMRs) were computed based on sex, race and ethnicity, and state. Trends over the study period were evaluated using a simple linear regression model.

Results: From 1999 to 2020, we identified 27,213 deaths with SLE as the underlying cause in the United States. Female participants experienced a higher AAMR (6.21 per million, 95% confidence interval [95% CI] 6.13-6.29) than male participants (1.20 per million, 95% CI 1.16-1.24). African American participants had the highest AAMR (10.7 per million, 95% CI 10.48-10.92), particularly among female participants (17.68 per million, 95% CI 17.29-18.06). Linear regression analysis found a significant decline in the SLE AAMR from 1999 to 2020 (R² = 0.902), with decreases noticed across all demographic groups. The SLE AAMR to the non-SLE AAMR ratio showed a sustained decline from 2005 to 2020 (R² = 0.8552). Analysis of the geographic distribution of SLE AAMR in the United States reveals a pronounced concentration in Southern states.

Conclusion: Since 1999, SLE-related mortality rates have consistently declined across various demographic groups, though rates remain disproportionately high in African American participants, particularly among African American female participants and in Southern states.