Systemic lupus erythematosus-related mortality declined but disparities persisted in the United States: a nationwide multiple-cause-of-death analysis, 1999-2023.

Authors

Yuhuan Song, Yan Zhang, Li Luo, Xiuju Yang, Kaide Xia

Published in

Frontiers in immunology. Volume 17. Pages 1850485. Epub Jul 24, 2026.

Abstract

Systemic lupus erythematosus (SLE) causes substantial premature mortality. Contemporary national data on long-term SLE-related mortality and its demographic and geographic disparities in the United States remain limited, particularly across the transition into the COVID-19 era.
We conducted a nationwide observational study using the 1999-2023 CDC WONDER Multiple Cause of Death database. SLE-related mortality was defined as any death certificate mention of SLE (ICD-10 M32). An underlying-cause-only sensitivity analysis assessed trend robustness. Annual deaths and age-adjusted mortality rates (AAMRs) were examined overall and by sex, age, race, geography, and urbanization. Temporal trends were evaluated using joinpoint regression to estimate annual percent changes (APCs) and average annual percent changes (AAPCs). Pooled state-level AAMRs were compared between 2016-2019 and 2020-2023.
From 1999 to 2023, the national SLE-related AAMR declined from 1.03 to 0.73 per 100,000 (overall AAPC, -1.46%), while annual deaths increased slightly from 2,197 to 2,291. Joinpoint analysis identified a significant decline during 1999-2014, an increase during 2014-2021, and a sharp decline during 2021-2023. Women consistently had higher AAMRs than men. Adults aged ≥65 years had the highest mortality burden with little overall improvement. Black individuals maintained the highest AAMRs throughout, despite experiencing the steepest long-term decline. Geographically, the South, HHS Region 6, and Oklahoma remained high-burden areas. Nonmetropolitan areas showed smaller overall declines and steeper late-period increases. The underlying-cause-only sensitivity analysis also showed an AAMR decline from 0.59 to 0.29 per 100,000 (AAPC, -3.23%).
U.S. SLE-related mortality declined overall from 1999 to 2023, but the absolute burden remained substantial and unequally distributed across demographic and geographic strata. Persistent excess mortality among women, older adults, Black individuals, and residents of high-burden areas highlights the need for more equitable translation of advances in lupus care into real-world survival gains.

PMID:
42568564
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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