Review of Georgia Lupus Registry Affirms Race Disparities and Premature Mortality
Lupus disproportionately affects women and minorities, particularly those of African ancestry. Research indicates that blacks with systemic lupus erythematosus (SLE) also have more severe disease and develop lupus at an earlier age. The Center for Disease Control and Prevention supports a network of national lupus registries in select counties throughout the country. The Georgia Lupus Registry (GLR) was designed to capture all residents with diagnosed SLE in two counties (Fulton and DeKalb) in the Atlanta metropolitan area with large black populations.
Researchers analyzed the GLR database for SLE mortality rates for both incident (new) and prevalent (existing) patients using the National Death Index. SLE patients had 2-3 times higher mortality than expected. Their review found evidence of racial disparities. Blacks had significantly greater cumulative mortality than whites and were significantly younger at death for both incident (51.8 vs. 64.4 years, respectively) and prevalent (52.3 vs. 65.0 years, respectively) cases. Black females with prevalent SLE were three times more likely to die than were black females in the general population. Blacks were also younger at death than whites for both incident and prevalent cases.
Whites had a marked lower mortality in the years immediately after diagnosis compared with blacks. No deaths were observed among whites until five years after SLE diagnosis, whereas blacks had significant and persistent higher mortality from the start. Additionally, it took whites with SLE 10 years to achieve the same cumulative mortality proportion (9%) seen in blacks with SLE in just two years. Given that the prevalence of SLE in blacks is three times that in whites to begin with is further evidence of the impact of SLE among blacks.
Racial disparities in care and treatment of people with lupus has been previously reported. This research underscores the urgency to define and address reversible mortality factors to mitigate disparities and improve overall outcomes for those with lupus. The Lupus Foundation of America, American College of Rheumatology and CDC are working together to encourage early detection and treatment, enhance the self-management skills of those with lupus, and improve health care providers’ ability to make accurate diagnoses. The researchers conclude that more similar efforts are needed.