Divergent racial trends in mortality from systemic lupus erythematosus

To compare trends in mortality from systemic lupus erythematosus (SLE) between black and white females in the United States.

Analysis of nationwide cause of death data collected by the National Center for Health Statistics, 1968 to 1991.

During the latter half of the 1968-91 period, trends in SLE mortality for black and white women under age 45 diverged and racial differences in total mortality from SLE widened. Among white females, total SLE mortality has been stable since the late 1970s at a mean annual rate of 4.6 deaths per million. This stability results from a balance between declining risk among whites under age 45 and increasing in those beyond 55. Among blacks, total mortality has risen more than 30% since the late 1970s to a mean annual rate of 18.7 per million. This increase results from a combination of constant risk in black females under 45 and rising risk in women over 55.

Trends for whites are consistent with a shift in mortality from younger to older women. This shift can be explained by longer postdiagnosis survival resulting from improved clinical management of SLE. The trends for blacks imply higher prevalence of SLE among black females than previously recognized and/or the existence of some impediment to young black females sharing in the full benefits of effective treatment.