Systemic lupus erythematosus in three ethnic groups. VIII. Predictors of early mortality in the LUMINA cohort

Objective. To determine the features associated with mortality in a multiet hnic US cohort of patients with systemic lupus erythematosus (SLE) within 5 years of study onset. Methods. Socioeconomic and demographic features (age, gender, ethnicity, ma rital status, education, occupation, poverty, and health-related behaviors [drinking, smoking, exercising]), clinical and immunologic features (diseas e duration, disease onset type, disease activity according to the Systemic Lupus Activity Measure [SLAM], disease damage according to the Systemic Lup us International Collaborating Clinics [SLICC] Damage Index [SDI], number o f American College of Rheumatology criteria at diagnosis, organ system mani festations, fatigue and pain ratings, and medication usage and autoantibodi es), immunogenetic features (HLA class II genotypes), and behavioral and ps ychosocial features (social support, illness-related behaviors, and helples sness), as obtained at enrollment into the study, were compared between sur vivors and deceased patients. Logistic regression analysis was used to dete rmine significant independent risk factors for mortality. Results. Within 5 years of study onset, 34 of 288 patients have died. Fourt een deaths could be directly attributed to SLE and 11 to infections. In 1 p atient the cause of death could not be determined. In the remaining 8 patie nts the cause of death was neither infectious nor disease-related. There we re 10 deaths among Hispanics, 18 among African Americans, and 6 among Cauca sians (P < 0.05). Variables associated with mortality in the univariable an alyses included poverty, less than full-time employment, difficulty in acce ssing health care, shorter disease duration, cardiovascular and renal invol vement, higher serum creatinine levels and lower hematocrit values, higher SLAM and SDI scores, lower use of antimalarial drugs, and higher use of (so me) immunosuppressants. Specific autoantibodies and class II HLA genotypes were not associated with mortality. Poverty and higher baseline SLAM and SD I scores were independently associated with mortality in the multivariable analyses. Conclusions. Disease activity, disease damage, and poverty appear to be the most important determinants of mortality in this multiethnic: US cohort of SLE patients. These results have applicability to the management of patien ts with SLE, a disease that more severely affects disadvantaged minority po pulation groups.