Mortality among Hospitalized Individuals with Systemic Lupus Erythematosus in the United States between 2006 and 2016.

OBJECTIVE To evaluate time trends in mortality for hospitalized adults with systemic lupus erythematosus (SLE) compared to the general hospitalized population (GHP), and to identify factors associated with increased risk of death among hospitalized SLE patients. METHODS We used the National (Nationwide) Inpatient Sample to estimate all-cause mortality for adults discharged from U.S. community hospitals between 2006 and 2016. Poisson regression models were used to estimate the risk of in-hospital death among all patients, including demographics, socioeconomic factors, comorbidity score, hospital region, SLE diagnosis and race/ethnicity as covariates. RESULTS Among 340,467,049 hospitalizations analyzed, 1,903,279 had a discharge diagnosis of SLE. In adjusted analysis, the risk of inpatient death decreased among hospitalizations for patients with SLE from 2.2% to 1.5% (p-value<0.001) between 2006 and 2016. All of the decrease in SLE mortality occurred between 2006 and 2008; after 2008, mortality stabilized at a rate statistically similar to the GHP. Hospitalizations for Blacks, Hispanics, and Asian/Pacific Islanders with SLE were more likely to end in death compared to hospitalizations for either whites with SLE, or individuals of the same non-white race/ethnicity without SLE. CONCLUSIONS In the largest study of in-hospital SLE mortality published to date, we found significant improvements in mortality for U.S. hospitalized patients with SLE from 2006 until 2008, after which mortality stabilized at a level similar to that of the GHP. Our results also demonstrate a persistently high mortality burden among U.S. Blacks and Hispanics with SLE, and contribute new data revealing high mortality among Asian/Pacific Islanders with SLE.