Global epidemiology of systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease with protean manifestations that predominantly affects young women. Certain ethnic groups are more vulnerable than others to developing SLE and experience increased morbidity and mortality. Reports of the global incidence and prevalence of SLE vary widely, owing to inherent variation in population demographics, environmental exposures and socioeconomic factors. Differences in study design and case definitions also contribute to inconsistent reporting. Very little is known about the incidence of SLE in Africa and Australasia. Identifying and remediating such gaps in epidemiology is critical to understanding the global burden of SLE and improving patient outcomes. Mortality from SLE is still two to three times higher than that of the general population. Internationally, the frequent causes of death for patients with SLE include infection and cardiovascular disease. Even without new therapies, mortality can potentially be mitigated with enhanced quality of care. This Review focuses primarily on the past 5 years of global epidemiological studies and discusses the regional incidence and prevalence of SLE and top causes of mortality. In this Review, the authors summarize and discuss the existing evidence on the incidence, prevalence and mortality of systemic lupus erythematosus across different world regions, with a focus on studies from the past 5 years. The estimated incidence, prevalence and mortality of systemic lupus erythematosus (SLE) vary considerably between geographic regions. Factors that contribute to the variation across different regions include differences in ethnicity, environmental exposures and socioeconomic status but non-uniform SLE definitions and study design also contribute. Population-based studies in the developing world are urgently needed to understand the global burden of disease. Mortality in patients with SLE is still unacceptably high, being two to three times higher than that of the general population. Infectious diseases and cardiovascular disease are consistently top causes of death in patients with SLE. Even without the development of new therapies, SLE outcomes may be improved by focusing on remediable SLE-specific adverse conditions. The estimated incidence, prevalence and mortality of systemic lupus erythematosus (SLE) vary considerably between geographic regions. Factors that contribute to the variation across different regions include differences in ethnicity, environmental exposures and socioeconomic status but non-uniform SLE definitions and study design also contribute. Population-based studies in the developing world are urgently needed to understand the global burden of disease. Mortality in patients with SLE is still unacceptably high, being two to three times higher than that of the general population. Infectious diseases and cardiovascular disease are consistently top causes of death in patients with SLE. Even without the development of new therapies, SLE outcomes may be improved by focusing on remediable SLE-specific adverse conditions.