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Burden of Comorbidity in Systemic Lupus Erythematosus in the UK, 1999-2012
Frances Rees1, Michael Doherty2, Matthew Grainge2
1University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
Insights
Systemic lupus erythematosus (SLE) patients in the UK face significantly higher risks of cardiovascular disease, stroke, kidney failure, cancer, osteoporosis, and infections compared to the general population. This increased comorbidity burden highlights the need for comprehensive management strategies for SLE.
Area of Science:
- Rheumatology
- Epidemiology
- Public Health
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant associated health complications.
- Understanding the comorbidity profile of SLE patients is crucial for effective healthcare planning and patient management.
Purpose of the Study:
- To estimate the comorbidity burden associated with SLE in the United Kingdom population between 1999 and 2012.
- To compare the incidence of major diseases in SLE patients versus a matched control group.
Main Methods:
- A retrospective cohort study utilized the UK Clinical Practice Research Datalink.
- 7,732 prevalent SLE cases were matched with 28,079 controls.
- Incidence rates of cardiovascular disease (CVD), stroke, end-stage renal failure (ESRF), cancer, osteoporosis, and infection were calculated and compared using Poisson regression.
Main Results:
- SLE patients exhibited significantly higher incidence rates for CVD, stroke, ESRF, cancer, osteoporosis, and infection compared to controls.
- Adjusted incidence rate ratios (IRRs) indicated elevated risks across all studied conditions.
- Men with SLE showed increased rates of CVD, stroke, and cancer, while women had higher rates of infection and osteoporosis. Younger patients faced the greatest relative risk.
Conclusions:
- Individuals with SLE in the UK experience a substantially greater burden of comorbidity.
- SLE patients are at a significantly higher risk of developing major adverse health outcomes, including cardiovascular events, renal failure, cancer, bone disease, and infections.
- These findings underscore the importance of proactive monitoring and management of comorbidities in SLE patients.
Objective:
To estimate the comorbidity associated with systemic lupus erythematosus (SLE) in the UK during 1999-2012.
Methods:
A retrospective cohort study using the UK Clinical Practice Research Datalink was conducted. Prevalent cases of SLE were matched by age, sex, and practice to 4 controls. The incidence of cardiovascular disease (CVD), stroke, end-stage renal failure (ESRF), cancer, osteoporosis, and infection were calculated per 1,000 person-years during the study period and compared to controls using Poisson regression to obtain incidence rate ratios (IRRs). IRRs were adjusted for baseline age, sex, body mass index, smoking status, alcohol intake, hypertension, hyperlipidemia, Charlson Index scores, and prednisolone use. Age- and sex-specific incidence rates were calculated.
Results:
When comparing the 7,732 prevalent cases of SLE with 28,079 matched controls, the unadjusted IRR was 1.98 (95% confidence interval [95% CI] 1.69-2.31) for CVD, 1.81 (95% CI 1.49-2.19) for stroke, 7.81 (95% CI 4.68-13.05) for ESRF, 1.28 (95% CI 1.17-1.40) for cancer, 2.53 (95% CI 2.27-2.82) for osteoporosis, and 1.49 (95% CI 1.40-1.58) for infection. After adjustment, the rates remained significantly higher in cases. Men with SLE had higher rates of CVD, stroke, and cancer, whereas women had higher rates of infection and osteoporosis. Those at younger ages were at the greatest relative risk compared with controls. Cases had significantly higher Charlson Index scores at baseline.
Conclusion:
People with SLE in the UK have a greater burden of comorbidity and are more likely to develop CVD, stroke, ESRF, cancer, osteoporosis, and infection than people of the same age and sex.
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