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

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.

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.

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.

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.