POS1164 REDUCED CLINIC ATTENDANCE AND INCREASED HOSPITAL ADMISSIONS ASSOCIATE WITH REDUCED SURVIVAL IN SYSTEMIC LUPUS ERYTHEMATOSUS, WHILST THE INFLUENCE OF ETHNICITY APPEARS LIMITED
Authors: S. Patel, M. A. Adas, R. Salerno, D. Nagra, Z. Yang, K. Bramham, C. Wincup, P. Gordon
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic lupus erythematosus (SLE) is inherently discriminatory, with a higher incidence in females and in those of African ancestry. Longitudinal data has helped to explore the association of damage and mortality across ethnic groups; however, most studies report low numbers of patients from Black ethnicities. <h3>Objectives:</h3> The primary aim was to describe the survival of a tertiary centre SLE cohort by ethnicity, the majority of whom identified as Black. Our secondary objectives were to describe the association of clinic attendance, medication concordance and hospital admissions with all-cause mortality. <h3>Methods:</h3> We examined the electronic health records for patients known to our centre with a clinician-recorded diagnosis of SLE between 1<sup>st</sup> June 2012 and 15<sup>th</sup> June 2023. We excluded those not seen in the previous 2 years and that died more than 5 years after their most recent appointment. Variables included ethnicity, index of multiple deprivation (IMD), diagnosis date, outpatient attendances, hospital admissions, end-stage renal failure and date of death. The collection of hospital-ordered prescriptions for disease modifying therapy was used as a surrogate for medication concordance. Individuals diagnosed during the study period formed our incident cohort. Cox regression models were used where appropriate. <h3>Results:</h3> We identified 328 eligible patients with 3494 person-years (py) of follow up during the study period, of which 83 were newly diagnosed during that time with 472 py of follow up (our incident cohort). In total, 31 patients died during this period (mortality rate 8.90/1000 py [6.24 - 12.62]) with 4 deaths in the incident cohort. These 4 patients had a mean time from diagnosis to death of 2.78 years (± 1.46) at an average age of 37.47 years old (± 13.35). Interestingly, there was no significant difference in the risk of death between Black and White ethnicities in the adjusted regression model (Figure 1). Age at diagnosis had no impact on the hazard rate of death in the multivariate model (adjusting for sex and ethnicity). However, 10 out of the 15 patients who died with a recorded SLE diagnosis date were diagnosed at &lt;40 years old. Rheumatology clinic attendance was consistent across all ethnic groups (Table 1). Poor clinic attendance (&lt;80%) was associated with an increased risk of death (HR 3.71 [1.21 – 11.36]) in the adjusted model. Furthermore, higher rates of hospital admissions per year were associated with an increased risk of death (HR 2.57 [1.57 - 4.22]). Two or more hospital admissions per year were seen in 10.79% of Black patients (84.62% of whom were from the lowest 2 IMD quintiles), 0% of White patients and 50% of those &lt;40 years old. Medication collection percentages were recorded for 221 patients (Table 1) with no significant relationship to mortality. 16 patients reached end-stage renal failure, 3 within our incident cohort (incidence rate 6.33/1000 py) with a mean time from diagnosis to ESRF of 3.91 years (± 5.14). <h3>Conclusion:</h3> Overall, there was no association between ethnicity and survival in our entire nor incident cohort. However, patients of Black ethnicity had higher rates of hospital admissions and ESRF compared to those of White ethnicity. Expectedly, poor clinic attendance and higher hospital admission rates were associated with an increased risk of death. However, there was no discernible association between medication collection and death in our study, likely due to assumptions in our methods. Our cohort is unique within the UK with a high proportion of patients from Black ethnicities. Additionally, we demonstrated a lower mortality rate than previously seen by Rees et al. [1]; however, they examined a large incident cohort and prior to the regular use of biologic agents. These findings emphasise the need to optimise clinic attendance and reduce hospital admissions in order to improve survival. Further qualitative work is planned to investigate any barriers to care, with an emphasis on bridging the cultural differences for our ethnically diverse cohort. <h3>REFERENCES:</h3> [1] Rees F, Doherty M, Grainge MJ, Lanyon P, Davenport G, Zhang W. Mortality in SLE in the United Kingdom 1999-2012. Rheumatology. 2016 May;55(5):854-60. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Samir Patel: None declared, Maryam A. Adas: None declared, Rosaria Salerno: None declared, Deepak Nagra: None declared, Zijing Yang: None declared, Kate Bramham Research grant support from Astrazeneca, Chris Wincup: None declared, Patrick Gordon: None declared.