SLE Mortality Declines Over 20 Years, But Racial and Regional Disparities Persist

An analysis of systemic lupus erythematosus (SLE) mortality in the United States from 1999 to 2020 has shown a sustained national decline in age-adjusted mortality rates (AAMRs) across demographic groups. However, the study also identified persistent disparities, with the highest mortality rates among African American individuals—particularly African American women—and a geographic concentration in Southern states.

Using data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research Multiple Cause of Death database, researchers identified 27,213 deaths with SLE listed as the underlying cause over the 22-year study period. The analysis computed AAMRs by sex, race and ethnicity, and state, and assessed time trends using linear regression models.

Female individuals experienced significantly higher SLE mortality than male individuals, with an AAMR of 6.21 per million (95% CI, 6.13–6.29) compared with 1.20 per million (95% CI, 1.16–1.24), respectively. The highest mortality burden was observed in African American participants, with an AAMR of 10.7 per million (95% CI, 10.48–10.92). Among African American women, the rate was nearly threefold higher, at 17.68 per million (95% CI, 17.29–18.06).

Geographic differences in SLE mortality were also notable. “Analysis of the geographic distribution of SLE AAMR in the United States reveals a pronounced concentration in Southern states,” the authors reported, indicating regional variation that may reflect differences in access to care, environmental exposures, or population risk factors.

Despite these disparities, the overall national trend was encouraging. The linear regression analysis demonstrated a statistically significant decline in the SLE AAMR from 1999 to 2020, with a high coefficient of determination (R² = 0.902), suggesting a consistent downward trend over time.

Further, the ratio of SLE to non-SLE mortality rates also decreased during the latter half of the study period. “The SLE AAMR to the non-SLE AAMR ratio showed a sustained decline from 2005 to 2020 (R² = 0.8552),” according to the study. This decline suggests improved survival among individuals with SLE relative to the general population.

The findings highlight critical considerations for rheumatologists and health systems. While therapeutic advances and earlier recognition of SLE may contribute to overall mortality improvements, the persistent excess mortality in African American individuals—especially women—emphasizes the need for targeted interventions. Strategies addressing health equity, timely diagnosis, and long-term management are essential to closing the gap in SLE outcomes.

The authors concluded, “Since 1999, SLE-related mortality rates have consistently declined across various demographic groups, though rates remain disproportionately high in African American participants, particularly among African American female participants and in Southern states.”

For clinicians, these data underscore the importance of recognizing SLE risk in high-burden populations and advocating for resource allocation that supports equitable care access, monitoring, and treatment. Ongoing efforts to address geographic and racial disparities remain central to further reducing mortality in SLE.

Reference
Daoud A, Dweik L, Pamuk O. Temporal trends and demographic insights into mortality from systemic lupus erythematosus, 1999-2020. Arthritis Care Res (Hoboken). Published online February 12, 2025. doi:10.1002/acr.25509