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Race/Ethnicity and Cardiovascular Events Among Patients With Systemic Lupus Erythematosus.
Arthritis Rheumatol. 2017 09; 69(9):1823-1831.AR

Abstract

OBJECTIVE

Systemic lupus erythematosus (SLE) is more prevalent and results in more severe outcomes among blacks, Asians, and Hispanics than among whites. Cardiovascular disease (CVD) is the leading cause of death among SLE patients. We undertook this study to examine racial/ethnic variations in risk of CVD events among SLE patients.

METHODS

Within the Medicaid Analytic eXtract from 2000 to 2010, we identified patients ages 18-65 years with SLE (≥3 International Classification of Diseases, Ninth Revision 710.0 codes, ≥30 days apart) and with ≥12 months of continuous enrollment. Subjects were followed up from the index date to the first CVD event (myocardial infarction [MI] or stroke), death, disenrollment, loss to follow-up, or end of follow-up period. Race/ethnicity-specific annual CVD event rates were calculated. Cox regression models estimated hazard ratios (HRs) with 95% confidence intervals (95% CIs), accounting for competing risk of death and adjusting for baseline demographics and comorbidities.

RESULTS

Of 65,788 SLE patients, 93.1% were women and ∼42% were black, 38% were white, 16% were Hispanic, 3% were Asian, and 1% were American Indian/Alaska Native. Mean ± SD follow-up was 3.8 ± 3.1 years. CVD event rates were highest among blacks (incidence rate [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 a lower risk of MI (HR 0.61 [95% CI 0.48-0.77] and HR 0.57 [95% CI 0.34-0.96], respectively), while blacks and Hispanics had a higher risk of stroke (HR 1.31 [95% CI 1.15-1.49] and HR 1.22 [95% CI 1.03-1.44], respectively).

CONCLUSION

Among SLE patients enrolled in Medicaid, the risk of MI was lower among Hispanics and Asians compared to whites, while the risk of stroke was elevated among blacks and Hispanics compared to whites.

Authors+Show Affiliations

Brigham and Women's Hospital, Boston, Massachusetts.Brigham and Women's Hospital, Boston, Massachusetts.Brigham and Women's Hospital, Boston, Massachusetts.Universidad de Antioquia, Medellín, Colombia.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

28598016

Citation

Barbhaiya, Medha, et al. "Race/Ethnicity and Cardiovascular Events Among Patients With Systemic Lupus Erythematosus." Arthritis & Rheumatology (Hoboken, N.J.), vol. 69, no. 9, 2017, pp. 1823-1831.
Barbhaiya M, Feldman CH, Guan H, et al. Race/Ethnicity and Cardiovascular Events Among Patients With Systemic Lupus Erythematosus. Arthritis & rheumatology (Hoboken, N.J.). 2017;69(9):1823-1831.
Barbhaiya, M., Feldman, C. H., Guan, H., Gómez-Puerta, J. A., Fischer, M. A., Solomon, D. H., Everett, B., & Costenbader, K. H. (2017). Race/Ethnicity and Cardiovascular Events Among Patients With Systemic Lupus Erythematosus. Arthritis & Rheumatology (Hoboken, N.J.), 69(9), 1823-1831. https://doi.org/10.1002/art.40174
Barbhaiya M, et al. Race/Ethnicity and Cardiovascular Events Among Patients With Systemic Lupus Erythematosus. Arthritis & rheumatology (Hoboken, N.J.). 2017;69(9):1823-1831. PubMed PMID: 28598016.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Race/Ethnicity and Cardiovascular Events Among Patients With Systemic Lupus Erythematosus. AU - Barbhaiya,Medha, AU - Feldman,Candace H, AU - Guan,Hongshu, AU - Gómez-Puerta,Jose A, AU - Fischer,Michael A, AU - Solomon,Daniel H, AU - Everett,Brendan, AU - Costenbader,Karen H, Y1 - 2017/08/13/ PY - 2016/10/11/received PY - 2017/06/06/accepted PY - 2017/6/10/pubmed PY - 2017/9/22/medline PY - 2017/6/10/entrez SP - 1823 EP - 1831 JF - Arthritis & rheumatology (Hoboken, N.J.) VL - 69 IS - 9 N2 - OBJECTIVE: Systemic lupus erythematosus (SLE) is more prevalent and results in more severe outcomes among blacks, Asians, and Hispanics than among whites. Cardiovascular disease (CVD) is the leading cause of death among SLE patients. We undertook this study to examine racial/ethnic variations in risk of CVD events among SLE patients. METHODS: Within the Medicaid Analytic eXtract from 2000 to 2010, we identified patients ages 18-65 years with SLE (≥3 International Classification of Diseases, Ninth Revision 710.0 codes, ≥30 days apart) and with ≥12 months of continuous enrollment. Subjects were followed up from the index date to the first CVD event (myocardial infarction [MI] or stroke), death, disenrollment, loss to follow-up, or end of follow-up period. Race/ethnicity-specific annual CVD event rates were calculated. Cox regression models estimated hazard ratios (HRs) with 95% confidence intervals (95% CIs), accounting for competing risk of death and adjusting for baseline demographics and comorbidities. RESULTS: Of 65,788 SLE patients, 93.1% were women and ∼42% were black, 38% were white, 16% were Hispanic, 3% were Asian, and 1% were American Indian/Alaska Native. Mean ± SD follow-up was 3.8 ± 3.1 years. CVD event rates were highest among blacks (incidence rate [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 a lower risk of MI (HR 0.61 [95% CI 0.48-0.77] and HR 0.57 [95% CI 0.34-0.96], respectively), while blacks and Hispanics had a higher risk of stroke (HR 1.31 [95% CI 1.15-1.49] and HR 1.22 [95% CI 1.03-1.44], respectively). CONCLUSION: Among SLE patients enrolled in Medicaid, the risk of MI was lower among Hispanics and Asians compared to whites, while the risk of stroke was elevated among blacks and Hispanics compared to whites. SN - 2326-5205 UR - https://www.unboundmedicine.com/medline/citation/28598016/Race/Ethnicity_and_Cardiovascular_Events_Among_Patients_With_Systemic_Lupus_Erythematosus_ L2 - https://doi.org/10.1002/art.40174 DB - PRIME DP - Unbound Medicine ER -