POS0735 CHANGES IN PROPORTIONATE MORTALITY PATTERN IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN THE UNITED STATES FROM 1999 TO 2020
Authors: M. Magrey, O. Pamuk, A. Daoud
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic lupus erythematosus (SLE) mortality is higher than the general population, with one study identifying a standardized mortality ratio of 2.6 higher than the general population. Despite improvement in SLE management, mortality remains high either due to persistent disease activity, co-morbidities, or complications of therapy. <h3>Objectives:</h3> In this study, we aimed to determine age-adjusted proportionate mortality (PM) patterns in patients with SLE in the last two decades in the USA. <h3>Methods:</h3> This retrospective cohort study utilized multiple causes of death files from the CDC WONDER database between 1999 and 2020. The data set contains death certificates for US residents, in which the underlying cause of death is ascertained by the treating physician. Each certificate identifies demographic information, a single underlying cause of death, and up to 20 additional contributory causes of death. We investigated trends over time for the AAMR and PM between 1999 to 2020 for the SLE and the general US population. We compared average AAMRs due to specific disease subgroups in the first three years (1999-2001) to the average in the last 3 years (2018-2020) using linear regression analysis. The absolute difference between PM for each study year was also calculated. <h3>Results:</h3> 47,337 deaths in SLE and 56,806,341 deaths in the general population occurred between 1999 and 2020. Over the last two decades, the AAMR has declined significantly in both SLE (1999: 4.67, 2020: 3.29 per million) and the general US population (1999: 8,576. 2020: 8,354 per million). The ratio of the SLE AAMR to the general population AAMR remained stable between 1999 and 2005, then the ratio showed a sustained decline until 2020. In the SLE population, age-adjusted PM significantly increased for malignant neoplasms (MNs) (5% vs 5.8%), and nervous system disorders (NSDs) (0.1% vs. 1.4) and decreased for infectious diseases (IDs) (2% vs. 0.4%), and ischemic heart disease (IHD) (7% vs. 3.5%). PM for hypertensive heart disease (HTNHD), cerebrovascular disease (CRBVD), and renal failure (RF) remained stable in SLE (Table 1). In the general population, age-adjusted PM significantly increased for IDs (7.4% vs 8.9%), diabetes/obesity/metabolic syndrome (DMOMS) (11.9% vs. 15.6%), HTNHD (8.7% vs. 18.2%), NSDs (7.9% vs. 12.5%), and respiratory diseases (25.8% vs. 27.2%). PM significantly decreased for MNs (25.5% vs. 21.7%), all cardiovascular diseases (CVDs) (39.3% vs. 28.9%), IHD (27.9% vs. 18.3%), CRBVDs (11.7% vs. 8.7%), and RF (8.1% vs. 7%) in the general population (Table 1). The absolute difference of PM between the general population and SLE for all CVDs (Figure 1A), IHD (Figure 1B), CRBVD (Figure 1C), and MNs (Figure 1D) significantly decreased from 1999 to 2020. In contrast, the absolute difference of PM between the general population and SLE for HTNHD, IDs, NSDs, and DMOMS significantly increased from 1999 to 2020 (Table 1). <h3>Conclusion:</h3> In SLE, AAMR significantly decreased when compared to the general population after 2005. In the recent 2 decades, there was reduced PM for CVDs, IHDs, and CRBVD in SLE group than the general population. While PM for MNs decreased in the general population, it increased in SLE. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>