Article Text

Download PDFPDF

BD-11 Lack of heterogeneity across race/ethnic groups in the risk of common comorbidities among patients with SLE compared to the general population in a large healthcare system in california
  1. Titilola Falasinnu1,
  2. Jiang Li2,
  3. Sukyung Chung2,
  4. Latha Palaniappan3 and
  5. Julia F Simard1,4
  1. 1Department of Health Research and Policy, Stanford School of Medicine, Stanford, California, USA
  2. 2Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
  3. 3Division of Primary Care and Population Health, Stanford School of Medicine, Stanford, California, USA
  4. 4Division of Immunology and Rheumatology, Stanford School of Medicine, Stanford, California, USA


Background Systemic lupus erythematosus (SLE) disproportionately affects racial/ethnic minorities and is an independent risk factor for pneumonia, infections, renal disease and cardiovascular diseases (CVD). There are also racial/ethnic differences in these common comorbidities. There is limited understanding of how much inequality or heterogeneity SLE confers independently of the underlying disease pathways of comorbidities between race/ethnic groups. We examined the patterns, strength and direction of the risk of comorbidities in race/ethnic groups with SLE compared to controls. We hypothesized that those with SLE will have increased risk of comorbidities and that these associations will be strongest for racial minorities and weakest for non-Hispanic whites (NHW).

Methods We defined a cohort using electronic health records data (2005–2016) from a large healthcare organization in California serving patients of diverse racial/ethnic backgrounds. The eligible population included SLE patients and age-sex-race/ethnicity matched non-SLE patients (≥18 years of age). SLE diagnosis was the primary exposure defined using ICD9: 710.0 and ICD10: M32.1, M32.8, and M32.9. The following outcomes were identified: pneumonia, infections, renal disease and CVD. For each racial/ethnic group, we calculated the proportion of incident comorbidities among SLE cases and controls, and then built adjusted logistic regression models for each outcome with SLE as the exposure.

Results We identified 1,290 SLE cases and 12 900 controls. The median age at baseline was 43 years and 92% of the cohort was female. Among SLE cases, 38% were NHW, 13% were Hispanic, 4% were Black, and 25% were Asian/Pacific Islander. Compared to controls, SLE cases had higher incidence of pneumonia (32% vs 18%), infections (46% vs 26%), renal disease (16% vs 3%) and CVD (45% vs 22%). The association persisted with odds ratio (OR) of 1.5 to 3, after adjusting for confounders (p<0.01). In subgroups analysis, ORs were similar across all racial/ethnic groups. We found no evidence for heterogeneity in the patterning of increased odds of the comorbidities between race/ethnic groups. For example, NHW, Blacks, Hispanics and Asians with SLE had between 2–3 times increased odds of CVD compared to controls.

Conclusions Our findings suggest that SLE similarly increases the risk of pneumonia, infections, renal disease and cardiovascular diseases (CVD) across racial/ethnic groups. Understanding the reasons for the lack of heterogeneity is important for targeting preventative interventions among patients with SLE.

Acknowledgements The authors would like to gratefully acknowledge the National Heart, Lung, and Blood Institute for funding this research.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.