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Abstract
Background Systemic lupus erythematosus (SLE) is becoming a public health concern because of increasing disease and economic burdens. However, epidemiological data on SLE, especially its incidence rate, were limited in China. We aimed to investigate the incidence, prevalence, and cost burdens of SLE in urban Chinese.
Methods We conducted a population-based study using national databases, Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance, in China between 2013 and 2017. Data from over 380 million patients were analyzed, and a total of 132,258 SLE patients (mean age 43.03 years, 81.34% female) were identified. Incident cases were individuals with a diagnosis of SLE with a 3-year disease-free period. Prevalent cases were patients with at least 1 insurance claim record with the diagnosis of SLE. Primary outcomes, including overall, age-, gender-, and region-specific incidence and prevalence rates of SLE, were estimated by a two-stage approach assuming a Poisson distribution. Associated annual costs and hospital visit times were also calculated.
Results The crude incidence and prevalence of SLE in China in 2017 were 14.96 (95%CI, 12.69–17.43) and 50.37 (95%CI, 44.19–56.95) per 100,000 person-years, suggesting incident and prevalent populations of 0.21 and 0.71 million (figure 1). The average annual rate of increase in prevalence was 16.86% during 2013 and 2017. The age-specific incidence and prevalence showed unimodal distributions, peaked at 30–49 and 40–49 years old in females and males respectively. The average estimated annual cost was US$1,599.34 in SLE patients. Female outpatients had higher costs with more hospital visits, whereas male inpatients had higher costs. Costs of adolescent and young adult patients were the highest among age groups.
Conclusions Rapidly expanding SLE population and increasing costs associated with SLE have placed considerable burdens on health systems in China. Enhanced efforts are needed to make long-term care more accessible and cost-effective for SLE patients, especially young population.
Figure Incidence and prevalence of SLE in urban China from 2013 to 2017 A: Crude and standardized incidence of SLE (the standardized incidence is based on 2010 China census data) in 2016 and 2017. B: Age- and gender-stratified incidence of SLE in 2017. C: Crude and D: Standardized prevalence of SLE (the standardized prevalence is based on 2010 China census data) from 2013 to 2017. E: Age-stratified prevalence of SLE in female and F: male from 2013 to 2017
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