Because Drs. Katz and Yelin are Editors of Arthritis Care & Research, review of this article was handled by the Editor of Arthritis & Rheumatism.
Systemic Lupus Erythematosus
Childhood-onset disease as a predictor of mortality in an adult cohort of patients with systemic lupus erythematosus
Article first published online: 16 MAR 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 8, pages 1152–1159, August 2010
How to Cite
Hersh, A. O., Trupin, L., Yazdany, J., Panopalis, P., Julian, L., Katz, P., Criswell, L. A. and Yelin, E. (2010), Childhood-onset disease as a predictor of mortality in an adult cohort of patients with systemic lupus erythematosus. Arthritis Care Res, 62: 1152–1159. doi: 10.1002/acr.20179
- Issue published online: 3 AUG 2010
- Article first published online: 16 MAR 2010
- Manuscript Accepted: 23 FEB 2010
- Manuscript Received: 9 JUL 2009
- National Center for Research Resources of the US Public Health Service. Grant Number: 5 M01-RR-0079
- Rosalind Russell Medical Research Center for Arthritis
- American College of Rheumatology Research and Education Foundation Physician Scientist Development award
- State of California Lupus Fund
- Arthritis Foundation
- Agency for Healthcare Research and Quality
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Numbers: R01-HS0-13893, P60-AR-053308
- NIH. Grant Numbers: K24-AR-02175, R01-AR-44804
- Kirkland Scholar Award
To examine childhood-onset disease as a predictor of mortality in a cohort of adult patients with systemic lupus erythematosus (SLE).
Data were derived from the University of California Lupus Outcomes Study, a longitudinal cohort of 957 adult subjects with SLE that includes 98 subjects with childhood-onset SLE. Baseline and followup data were obtained via telephone interviews conducted in 2002–2007. The number of deaths during 5 years of followup was determined and standardized mortality ratios (SMRs) for the cohort, and across age groups, were calculated. Kaplan-Meier life table analysis was used to compare mortality rates between childhood- (defined as SLE diagnosis at <18 years of age) and adult-onset SLE. Multivariate Cox proportional hazard models were used to determine predictors of mortality.
During the median followup period of 48 months, 72 deaths (7.5% of subjects) occurred, including 9 deaths (12.5%) in subjects with childhood-onset SLE. The overall SMR was 2.5 (95% confidence interval [95% CI] 2.0–3.2). In Kaplan-Meier survival analysis, after adjusting for age, childhood-onset subjects were at increased risk for mortality throughout the followup period (P< 0.0001). In a multivariate model adjusting for age, disease duration, and other covariates, childhood-onset SLE was independently associated with an increased mortality risk (hazard ratio [HR] 3.1, 95% CI 1.3–7.3), as was low socioeconomic status measured by education (HR 1.9, 95% CI 1.1–3.2), and end stage renal disease (HR 2.1, 95% CI 1.1–4.0).
Childhood-onset SLE was a strong predictor of mortality in this cohort. Interventions are needed to prevent early mortality in this population.