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Racial and Ethnic Differences in the Prevalence and Time to Onset of Manifestations of Systemic Lupus Erythematosus: The California Lupus Surveillance Project
Author(s) -
Maningding Ernest,
Dall'Era Maria,
Trupin Laura,
Murphy Louise B.,
Yazdany Jinoos
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23887
Subject(s) - pacific islanders , medicine , lupus nephritis , hazard ratio , poisson regression , systemic lupus erythematosus , confidence interval , population , demography , proportional hazards model , ethnic group , retrospective cohort study , disease , environmental health , sociology , anthropology
Objective The California Lupus Surveillance Project ( CLSP ) is a population‐based registry of individuals with systemic lupus erythematosus ( SLE ) residing in San Francisco County, California from 2007 to 2009, with a special focus on Asian/Pacific Islander and Hispanic patients. We used retrospective CLSP data to analyze racial and ethnic differences in lupus manifestations and in the timing and risk of developing severe manifestations. Methods A total of 724 patients with SLE were retrospectively identified. Prevalence ratios ( PR s) of SLE manifestations were calculated using Poisson regression models stratified by race/ethnicity and adjusted for sex, age at SLE diagnosis, and disease duration. We studied onset of severe SLE manifestations after SLE diagnosis using Kaplan‐Meier methods to examine time‐to‐event and Cox proportional hazards regression models to estimate hazard ratios ( HR s). White patients were the referent group in all analyses. Results African Americans, Asian/Pacific Islanders, and Hispanic patients had increased prevalence of renal manifestations ( PR 1.74 [95% confidence interval (95% CI ) 1.40–2.16], PR 1.68 [95% CI 1.38–2.05], and PR 1.35 [95% CI 1.05–1.74], respectively). Furthermore, African Americans had increased prevalence of neurologic manifestations ( PR 1.49 [95% CI 1.12–1.98]), and both African Americans ( PR 1.09 [95% CI 1.04–1.15]) and Asian/Pacific Islanders ( PR 1.07 [95% CI 1.01–1.13]) had increased prevalence of hematologic manifestations. African Americans, Asian/Pacific Islanders, and Hispanic patients, respectively, had higher risk of developing lupus nephritis ( HR 2.4 [95% CI 1.6–3.8], HR 4.3 [95% CI 2.9–6.4], and HR 2.3 [95% CI 1.4–3.8]) and thrombocytopenia ( HR 2.3 [95% CI 1.1–4.4], HR 2.3 [95% CI 1.3–4.2], and HR 2.2 [95% CI 1.1–4.7]). Asian/Pacific Islander and Hispanic patients had higher risk of developing antiphospholipid syndrome ( HR 2.5 [95% CI 1.4–4.4] and HR 2.6 [95% CI 1.3–5.1], respectively). Conclusion This is the first epidemiologic study comparing lupus manifestations among 4 major racial and ethnic groups. We found substantial differences in the prevalence of several clinical SLE manifestations among racial/ethnic groups and discovered that African Americans, Asian/Pacific Islanders, and Hispanic patients are at increased risk of developing several severe manifestations following a diagnosis of SLE .