Lupus a Major Unrecognized Cause of Death in Young Women, Study Reports

Systemic lupus erythematosus (SLE) is a major cause of death in young women that goes largely unrecognized due to its exclusion from an annual nationwide ranking, a new U.S. study shows.

Based on these findings, researchers believe that public health and research programs dedicated to the disease are warranted, and that including lupus as a leading cause of death could help guide government policy and reporting, research funding, and awareness of the disease.

The study, “Lupus — An Unrecognized Leading Cause of Death in Young Women: Population‐based Study Using Nationwide Death Certificates, 2000‐2015,” appeared in the journal Arthritis & Rheumatology.

Lupus predominantly affects women. Using the U.S. nationwide mortality database, researchers had previously determined that 84 percent of the 62,843 recorded lupus deaths were women.

They also found that despite a decrease in lupus mortality rates over the past five decades, deaths from this disease remain high compared with other causes. In fact, the ratio of lupus deaths versus non-lupus deaths increased by 34.6 percent from 1968 to 2013.

The Centers for Disease Control and Prevention’s National Vital Statistics System has a mortality database, covering more than 99 percent of deaths across the U.S. This database serves as an important indicator of the health of the U.S. population and is used to calculate the burden of specific diseases, as well as to guide healthcare policy planning and resource allocation.

The CDC also uses the database to create its annual leading causes-of-death ranking from a selected list of 113 causes. But this list does not include lupus. So to determine the relative burden of lupus deaths in women, investigators in this study ranked lupus among the CDC’s leading causes of death.

Results revealed that from 2000 to 2015, lupus was recorded as the underlying or contributing cause of death in 28,411 women.

It landed among the top 20 leading causes of death in girls and women between 5 and 64 years old, ranking 10th in the 15‐24 age group, 14th in the 25‐34 and 35‐44 age groups, and 15th in the 10‐14 age group.

Among black and Hispanic women, the disease ranked fifth in the 15‐24 age group, sixth for ages 25‐34, and eighth-ninth for ages 35‐44. The investigators said that the true disease burden in minorities may be underestimated due to under-recording of lupus deaths in less educated ethnic minority populations.

“Our findings underscore SLE as an important public health issue in young women, which should be addressed by targeted public health and research programs,” the researchers wrote. “The actual rankings for SLE would likely be even higher, because SLE may not be recorded on the death certificates in as many as 40% of patients with SLE in the U.S.”

This underestimation may be due to interpreting complications such as cardiovascular events, infections, renal failure, and respiratory diseases as unrelated to lupus, when in fact this disease predisposes them, the researchers said. Limited awareness of healthcare professionals of lupus as a potential cause of death in some patients may also contribute to this underrepresentation.

“An awareness campaign to educate primary care physicians and internists about the multi-organ complications of SLE and its varying presentations at the time of death may be helpful in future studies to assess the true burden of SLE mortality,” the scientists wrote.

In contrast, the team observed that other disorders may have a higher ranking than their actual burden due to overestimation of cardiovascular disease deaths.

“In conclusion, the inclusion of SLE in CDC’s selected list of causes of death for their annual ranking would highlight the importance of this disease as a major cause of death among young women,” the researchers said.