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Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus.
Semin Arthritis Rheum 2019; 48(5):840-846SA

Abstract

OBJECTIVE

Systemic lupus erythematosus (SLE), which is associated with increased stroke risk, is more prevalent and often more severe among Blacks, Asians, and Hispanics than Whites. We examined racial/ethnic variation in stroke rates and risks, overall and by hemorrhagic versus ischemic subtype, among SLE patients.

METHODS

Within Medicaid (2000-2010), we identified patients aged 18-65 with SLE (≥ 3 ICD-9 710.0 codes, ≥ 30days apart) and ≥12 months of continuous enrollment. Subjects were followed from index date to first stroke event, death, disenrollment, or end of follow-up. Race/ethnicity-specific annual event rates were calculated for stroke overall and by subtypes (hemorrhagic vs. ischemic). We used Cox proportional hazard models to estimate hazard ratios (HR) of stroke by race/ethnicity, adjusting for comorbidities and the competing risk of death.

RESULTS

Of 65,788 SLE patients, 93.1% were female. Racial/ethnic breakdown was 42% Black, 38% White, 16% Hispanic, 3% Asian, and 1% American Indian/Alaska Natives. Mean follow-up was 3.7 ± 3.0years. After multivariable adjustment, Blacks were at increased risk of overall stroke (HR 1.34 [95%CI 1.18-1.53), hemorrhagic stroke (HR 1.42 [1.00-2.01]), and ischemic stroke (HR 1.33 [1.15-1.52]) compared to Whites. Hispanics were at increased risk of overall stroke (HR 1.25 [1.06-1.47)] and hemorrhagic stroke (HR 1.79 [95% CI 1.22-2.61]), but not ischemic stroke, compared to Whites.

CONCLUSION

Among SLE patients enrolled in Medicaid, we observed elevated stroke risk (overall and by subtype) among Blacks and Hispanics compared to Whites, suggesting the importance of early recognition and screening for stroke risk factors among Blacks and Hispanics.

Authors+Show Affiliations

Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States. Electronic address: barbhaiyam@hss.edu.Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States.Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.Division of Cardiovascular and Preventive Medicine, Brigham and Women's Hospital, Boston, MA, United States.Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.

Pub Type(s)

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

Language

eng

PubMed ID

30205982

Citation

Barbhaiya, Medha, et al. "Racial/ethnic Variation in Stroke Rates and Risks Among Patients With Systemic Lupus Erythematosus." Seminars in Arthritis and Rheumatism, vol. 48, no. 5, 2019, pp. 840-846.
Barbhaiya M, Feldman CH, Guan H, et al. Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus. Semin Arthritis Rheum. 2019;48(5):840-846.
Barbhaiya, M., Feldman, C. H., Guan, H., Chen, S. K., Fischer, M. A., Solomon, D. H., ... Costenbader, K. H. (2019). Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus. Seminars in Arthritis and Rheumatism, 48(5), pp. 840-846. doi:10.1016/j.semarthrit.2018.07.012.
Barbhaiya M, et al. Racial/ethnic Variation in Stroke Rates and Risks Among Patients With Systemic Lupus Erythematosus. Semin Arthritis Rheum. 2019;48(5):840-846. PubMed PMID: 30205982.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus. AU - Barbhaiya,Medha, AU - Feldman,Candace H, AU - Guan,Hongshu, AU - Chen,Sarah K, AU - Fischer,Michael A, AU - Solomon,Daniel H, AU - Everett,Brendan M, AU - Costenbader,Karen H, Y1 - 2018/07/31/ PY - 2018/02/02/received PY - 2018/06/30/revised PY - 2018/07/23/accepted PY - 2020/04/01/pmc-release PY - 2018/9/13/pubmed PY - 2019/6/4/medline PY - 2018/9/13/entrez KW - CVA KW - Cardiovascular KW - Ethnicity KW - Medicaid KW - Race KW - Risk KW - SLE KW - Stroke KW - Systemic lupus erythematosus SP - 840 EP - 846 JF - Seminars in arthritis and rheumatism JO - Semin. Arthritis Rheum. VL - 48 IS - 5 N2 - OBJECTIVE: Systemic lupus erythematosus (SLE), which is associated with increased stroke risk, is more prevalent and often more severe among Blacks, Asians, and Hispanics than Whites. We examined racial/ethnic variation in stroke rates and risks, overall and by hemorrhagic versus ischemic subtype, among SLE patients. METHODS: Within Medicaid (2000-2010), we identified patients aged 18-65 with SLE (≥ 3 ICD-9 710.0 codes, ≥ 30days apart) and ≥12 months of continuous enrollment. Subjects were followed from index date to first stroke event, death, disenrollment, or end of follow-up. Race/ethnicity-specific annual event rates were calculated for stroke overall and by subtypes (hemorrhagic vs. ischemic). We used Cox proportional hazard models to estimate hazard ratios (HR) of stroke by race/ethnicity, adjusting for comorbidities and the competing risk of death. RESULTS: Of 65,788 SLE patients, 93.1% were female. Racial/ethnic breakdown was 42% Black, 38% White, 16% Hispanic, 3% Asian, and 1% American Indian/Alaska Natives. Mean follow-up was 3.7 ± 3.0years. After multivariable adjustment, Blacks were at increased risk of overall stroke (HR 1.34 [95%CI 1.18-1.53), hemorrhagic stroke (HR 1.42 [1.00-2.01]), and ischemic stroke (HR 1.33 [1.15-1.52]) compared to Whites. Hispanics were at increased risk of overall stroke (HR 1.25 [1.06-1.47)] and hemorrhagic stroke (HR 1.79 [95% CI 1.22-2.61]), but not ischemic stroke, compared to Whites. CONCLUSION: Among SLE patients enrolled in Medicaid, we observed elevated stroke risk (overall and by subtype) among Blacks and Hispanics compared to Whites, suggesting the importance of early recognition and screening for stroke risk factors among Blacks and Hispanics. SN - 1532-866X UR - https://www.unboundmedicine.com/medline/citation/30205982/Racial/ethnic_variation_in_stroke_rates_and_risks_among_patients_with_systemic_lupus_erythematosus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-0172(18)30059-3 DB - PRIME DP - Unbound Medicine ER -