Characteristics of comorbidities and costs among patients who died from systemic lupus erythematosus in Taiwan originating from Gram-negative bacteria [1]. In the USA, the increase in the number and the cost of avoidable hospitalizations has been remarkable among SLE patients [2]. Regarding mortality, a Mexican report has revealed a correlation between active lupus nephritis (LN) and infections [3]. A nationwide claim-based study in the USA has found that African Americans have higher mortality due to SLE than Caucasians [4]. Ward et al. reported the predictors of mortality such as age, sepsis, LN, respiratory failure and other indices among inpatients with SLE [5]. It is report- ed that lower socio-economic status correlated with in-hospital mortality rate of patients with SLE [6]. For genetic issues, the relationship between some genetic mutations and development of SLE has been discussed [7]. In Taiwan, National Health Insurance (NHI), which was launched in 1995, categorizes SLE as a catastrophic illness. According to the standard diagnostic criteria set forth by the American Col- lege of Rheumatology (ACR) [8, 9], those who are identified by clinical rheumatologists as having SLE as a catastrophic illness are exempt from the cost incurred by this disease in ambulatory as well as in-hospital cares [10]. Therefore, a complete registry of SLE has been established since then. A Taiwanese epidemiological study has revealed a trend of increasing prevalence but a declining incidence of SLE, and its incidence and prevalence in Taiwan were both higher than those in West- ern countries [11]. Another claim-based study has reported a significant role of experienced physi- cians in care of SLE patients, which can reduce in- hospital mortality from the disease [12]. Howev- er, the end-of-life issues of SLE patients in Taiwan remain unclear. The aim of this investigation was to delineate aforementioned issues from the repository of the database in NHI. Material and methods Design of the study Retrospective and claim-based analyses were con- ducted by collecting data regarding end-of-life hos- pitalization of patients with SLE from the National Health Insurance Research Database (NHIRD) from 2005 to 2007. The NHIRD is maintained by the National Health Research Institute, Taiwan, and pro- vides anonymous/encrypted NHI claim data to local academic institutes for related studies [13]. Hospi- talization claim data (DD 2005.DAT, DD 2006.DAT, and DD2007.DAT) were screened with the International Classification of Diseases, the 9th Revision Clinical Modification (ICD-9-CM) code of 710.0. The reason for discharge included in-hospital death, suicide, and critical discharge for home death (which is a ritual 22,484 Discharges with diagnosis of SLE in 2005-2007 (ICD-9-CM code 710.0) 362 Discharges resultated in in-hospital death or critical discharge for home death 60 Discharges without registration for catastrophic illness (excluded) 302 Discharges with registration for catastrophic illness (included) Figure 1. Algorithm for case collection belief of getting peace in another world abided by many Taiwanese). For accuracy of coding, those who were not registered with catastrophic illness in the NHI were excluded from the study. The study design is shown in Figure 1. Parameters Subjects’ general data, comorbidities and claims for charges were analyzed. The details of inpatients’ costs were converted into United States Dollars (USD) according to the closing exchange rate on December 31, 2007. The comorbidities were collect- ed according to related ICD-9-CM codes, which included sepsis or bacteremia (code 038.x, 790.7), acute respiratory failure (code 518.81), non-traumat- ic shock (code 785.5x), acute myocardial infarction (410.x, 411.x), acute cerebrovascular accident (code 430.x-434.x), acute low respiratory conditions (ALRC) (code 466.x, 480.x-486.x), urological infections (code 590.x, 595.x, 597.x, 599.x, 601.x), peptic ulcer or esophagitis (code 530.x-534.x), hypertensive diseases (code 401.x-405.x), heart failure (code 428.x), dia- betes mellitus (DM, code 250.x), cancers (code 140.x- 208.x) and nephropathy/nephritis (code 580.x-589.x, 791.0). Psychiatric disorders were not included due to possible underestimation of ICD coding in end-of- life hospitalizations. The study was conducted after approval by the National Health Research Institute, Taiwan (No. 99237). All the identity data of subjects was encrypted and analyzed anonymously. Statistical analysis Data in the text and tables are expressed as mean ± SD. SPSS software (version 17.0, SPSS Inc., Chicago, IL, USA) was used for multivariate logistic regression analysis to assess statistical significance. The correlated factors were presented as regres- sion coefficient (B), odds ratio (OR) and 95% confi- dence interval (CI). A p value of less than 0.05 was considered statistically significant (2-tailed tests). Arch Med Sci 4, August / 2012 691