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Serious infections among adult Medicaid beneficiaries with systemic lupus erythematosus and lupus nephritis.
Arthritis Rheumatol 2015; 67(6):1577-85AR

Abstract

OBJECTIVE

To examine the epidemiology of serious infections, a significant cause of morbidity and mortality in systemic lupus erythematosus (SLE), in a nationwide cohort of SLE and lupus nephritis (LN) patients.

METHODS

Using the Medicaid Analytic eXtract database for the years 2000-2006, we identified patients ages 18-64 years who had SLE and the subset who had LN. We ascertained cases of serious hospitalized infections using validated algorithms, and we determined 30-day mortality rates. Poisson regression was used to calculate infection incidence rates and multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) for the first infection, adjusted for sociodemographic variables, medication use, and an SLE-specific risk adjustment index.

RESULTS

We identified 33,565 patients with SLE, 7,113 of whom had LN. There were 9,078 serious infections in 5,078 SLE patients and 3,494 infections in 1,825 LN patients. The infection incidence rate per 100 person-years was 10.8 in the SLE cohort and 23.9 in the LN subcohort. In adjusted models for the SLE cohort, we observed increased risks of infection in men as compared to women (HR 1.33 [95% confidence interval (95% CI) 1.20-1.47]), in blacks as compared to whites (HR 1.14 [95% CI 1.06-1.21]), and in users of glucocorticoids (HR 1.51 [95% CI 1.43-1.61]) and immunosuppressive drugs (HR 1.11 [95% CI 1.03-1.20]) as compared to never users. Hydroxychloroquine users had a reduced risk of infection as compared to never users (HR 0.73 [95% CI 0.68-0.77]). The 30-day mortality rate per 1,000 person-years among those hospitalized with infections was 21.4 in the SLE cohort and 38.6 in the LN subcohort.

CONCLUSION

In this diverse, nationwide cohort of SLE patients, we observed a substantial burden of serious infections with many subsequent deaths, particularly among those with LN.

Authors+Show Affiliations

Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts.Hospital for Sick Children, Toronto, Ontario, Canada.Baylor College of Medicine, Houston, Texas.Brigham and Women's Hospital, Boston, Massachusetts.Brigham and Women's Hospital, Boston, Massachusetts.Brigham and Women's Hospital, Boston, Massachusetts.Brigham and Women's Hospital, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25772621

Citation

Feldman, Candace H., et al. "Serious Infections Among Adult Medicaid Beneficiaries With Systemic Lupus Erythematosus and Lupus Nephritis." Arthritis & Rheumatology (Hoboken, N.J.), vol. 67, no. 6, 2015, pp. 1577-85.
Feldman CH, Hiraki LT, Winkelmayer WC, et al. Serious infections among adult Medicaid beneficiaries with systemic lupus erythematosus and lupus nephritis. Arthritis & rheumatology (Hoboken, N.J.). 2015;67(6):1577-85.
Feldman, C. H., Hiraki, L. T., Winkelmayer, W. C., Marty, F. M., Franklin, J. M., Kim, S. C., & Costenbader, K. H. (2015). Serious infections among adult Medicaid beneficiaries with systemic lupus erythematosus and lupus nephritis. Arthritis & Rheumatology (Hoboken, N.J.), 67(6), pp. 1577-85. doi:10.1002/art.39070.
Feldman CH, et al. Serious Infections Among Adult Medicaid Beneficiaries With Systemic Lupus Erythematosus and Lupus Nephritis. Arthritis & rheumatology (Hoboken, N.J.). 2015;67(6):1577-85. PubMed PMID: 25772621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serious infections among adult Medicaid beneficiaries with systemic lupus erythematosus and lupus nephritis. AU - Feldman,Candace H, AU - Hiraki,Linda T, AU - Winkelmayer,Wolfgang C, AU - Marty,Francisco M, AU - Franklin,Jessica M, AU - Kim,Seoyoung C, AU - Costenbader,Karen H, PY - 2014/11/04/received PY - 2015/02/05/accepted PY - 2015/3/17/entrez PY - 2015/3/17/pubmed PY - 2015/8/8/medline SP - 1577 EP - 85 JF - Arthritis & rheumatology (Hoboken, N.J.) VL - 67 IS - 6 N2 - OBJECTIVE: To examine the epidemiology of serious infections, a significant cause of morbidity and mortality in systemic lupus erythematosus (SLE), in a nationwide cohort of SLE and lupus nephritis (LN) patients. METHODS: Using the Medicaid Analytic eXtract database for the years 2000-2006, we identified patients ages 18-64 years who had SLE and the subset who had LN. We ascertained cases of serious hospitalized infections using validated algorithms, and we determined 30-day mortality rates. Poisson regression was used to calculate infection incidence rates and multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) for the first infection, adjusted for sociodemographic variables, medication use, and an SLE-specific risk adjustment index. RESULTS: We identified 33,565 patients with SLE, 7,113 of whom had LN. There were 9,078 serious infections in 5,078 SLE patients and 3,494 infections in 1,825 LN patients. The infection incidence rate per 100 person-years was 10.8 in the SLE cohort and 23.9 in the LN subcohort. In adjusted models for the SLE cohort, we observed increased risks of infection in men as compared to women (HR 1.33 [95% confidence interval (95% CI) 1.20-1.47]), in blacks as compared to whites (HR 1.14 [95% CI 1.06-1.21]), and in users of glucocorticoids (HR 1.51 [95% CI 1.43-1.61]) and immunosuppressive drugs (HR 1.11 [95% CI 1.03-1.20]) as compared to never users. Hydroxychloroquine users had a reduced risk of infection as compared to never users (HR 0.73 [95% CI 0.68-0.77]). The 30-day mortality rate per 1,000 person-years among those hospitalized with infections was 21.4 in the SLE cohort and 38.6 in the LN subcohort. CONCLUSION: In this diverse, nationwide cohort of SLE patients, we observed a substantial burden of serious infections with many subsequent deaths, particularly among those with LN. SN - 2326-5205 UR - https://www.unboundmedicine.com/medline/citation/25772621/Serious_infections_among_adult_Medicaid_beneficiaries_with_systemic_lupus_erythematosus_and_lupus_nephritis_ L2 - https://doi.org/10.1002/art.39070 DB - PRIME DP - Unbound Medicine ER -