Race/Ethnicity and Cardiovascular Events among Patients with Systemic Lupus Erythematosus

Authors

  • Medha Barbhaiya MD, MPH,

    Corresponding author
    1. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    • Corresponding author and reprint requests: Medha Barbhaiya, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, #6016S, Boston, MA 02115, Phone: 617-732-5325, Fax: 617-732-5766, Email: mbarbhaiya@partners.org

    Search for more papers by this author
  • Candace H. Feldman MD, MPH,

    1. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    Search for more papers by this author
  • Hongshu Guan PhD,

    1. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    Search for more papers by this author
  • Jose A. Gómez-Puerta MD, MPH, PhD,

    1. Grupo de Inmunología Celular e Inmunogenética, GICIG, Universidad de Antioquia, Medellín, Colombia
    Search for more papers by this author
  • Michael A. Fischer MD, MS,

    1. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA
    Search for more papers by this author
  • Daniel H. Solomon MD, MPH,

    1. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    Search for more papers by this author
  • Brendan Everett MD, MPH,

    1. Divisions of Cardiovascular and Preventive Medicine, Brigham and Women's Hospital, Boston, MA
    Search for more papers by this author
  • Karen H. Costenbader MD, MPH

    1. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    Search for more papers by this author

Abstract

Objective: Systemic Lupus Erythematosus (SLE) is more prevalent with more severe outcomes among Blacks, Asians, and Hispanics than Whites. Cardiovascular disease (CVD) is the leading cause of death among SLE patients. We examined racial/ethnic variation in risk of CVD events among SLE patients.

Methods: Within Medicaid Analytic eXtract (2000-2010), we identified patients aged 18-65 with SLE (≥ 3 ICD-9 710.0 codes, ≥30 days apart) and ≥12 months of continuous enrollment. Subjects were followed from index date to first CVD event (myocardial infarction [MI] or stroke), death, disenrollment, or end of follow-up. Race/ethnicity-specific annual CVD event rates were calculated. Cox regression models estimated hazard ratios (HR), accounting for competing risk of death, adjusting for baseline demographics and comorbidities.

Results: Of 65,788 SLE patients, 93.1% were female and approximately 42% Black, 38% White, 16% Hispanic, 3% Asian and 1% American Indian/Alaska Native. Mean follow-up was 3.8 ±3.1 years. CVD event rates were highest among Blacks (IR 10.57 [95% CI 9.96-11.22]) and lowest among Asians (IR 6.63 [95% CI 4.97-8.85]). After multivariable adjustment, risk of CVD events was increased among Blacks (HR 1.14 [95%CI 1.03-1.26]) compared to Whites. Hispanics and Asians had lower MI risk (HR 0.61 [95% CI 0.48-0.77] and HR 0.57 [95% CI 0.34-0.96], respectively), whereas Blacks and Hispanics had higher stroke risk (HR 1.31 [95% CI 1.15-1.49] and HR 1.22 [95% CI 1.03-1.44]).

Conclusion: Among SLE patients enrolled in Medicaid, MI risk was lower among Hispanics and Asians, while stroke risk was elevated among Blacks and Hispanics compared to Whites. This article is protected by copyright. All rights reserved.

Ancillary