Dr. Solomon has received research grants from the Consortium of Rheumatology Researchers of North America (CORRONA) registry, Amgen, and Lilly, and serves in unpaid roles in two Pfizer trials.
Systemic Lupus Erythematosus
Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000–2004†
Version of Record online: 25 FEB 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 65, Issue 3, pages 753–763, March 2013
How to Cite
Feldman, C. H., Hiraki, L. T., Liu, J., Fischer, M. A., Solomon, D. H., Alarcón, G. S., Winkelmayer, W. C. and Costenbader, K. H. (2013), Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000–2004. Arthritis & Rheumatism, 65: 753–763. doi: 10.1002/art.37795
Presented in part at the 75th Annual Scientific Meeting of the American College of Rheumatology, Chicago, IL, November 2011.
- Issue online: 25 FEB 2013
- Version of Record online: 25 FEB 2013
- Accepted manuscript online: 30 NOV 2012 03:22PM EST
- Manuscript Accepted: 6 NOV 2012
- Manuscript Received: 24 JUL 2012
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
- NIH. Grant Number: R01-AR-057327
- NIAMS Clinical Orthopedic and Musculoskeletal Education and Training Program. Grant Number: T32-AR-055885
Systemic lupus erythematosus (SLE) and lupus nephritis (LN) disproportionately affect individuals who are members of racial/ethnic minority groups and individuals of lower socioeconomic status (SES). This study was undertaken to investigate the epidemiology and sociodemographics of SLE and LN in the low-income US Medicaid population.
We utilized Medicaid Analytic eXtract data, with billing claims from 47 states and Washington, DC, for 23.9 million individuals ages 18–65 years who were enrolled in Medicaid for >3 months in 2000–2004. Individuals with SLE (≥3 visits >30 days apart with an International Classification of Diseases, Ninth Revision [ICD-9] code of 710.0) and with LN (≥2 visits with an ICD-9 code for glomerulonephritis, proteinuria, or renal failure) were identified. We calculated SLE and LN prevalence and incidence, stratified by sociodemographic category, and adjusted for number of American College of Rheumatology (ACR) member rheumatologists in the state and SES using a validated composite of US Census variables.
We identified 34,339 individuals with SLE (prevalence 143.7 per 100,000) and 7,388 (21.5%) with LN (prevalence 30.9 per 100,000). SLE prevalence was 6 times higher among women, nearly double in African American compared to white women, and highest in the US South. LN prevalence was higher among all racial/ethnic minority groups compared to whites. The areas with lowest SES had the highest prevalence; areas with the fewest ACR rheumatologists had the lowest prevalence. SLE incidence was 23.2 per 100,000 person-years and LN incidence was 6.9 per 100,000 person-years, with similar sociodemographic trends.
In this nationwide Medicaid population, there was sociodemographic variation in SLE and LN prevalence and incidence. Understanding the increased burden of SLE and its complications in this low-income population has implications for resource allocation and access to subspecialty care.