Systemic lupus erythematosus, commonly known as lupus, is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. It can affect various parts of the body, including the joints, skin, kidneys, heart, lungs, and brain. While lupus can be a challenging condition to manage, medical advancements have improved the prognosis for many individuals, but lupus remains a condition that can lead to life-threatening complications. Understanding its impact on life expectancy and influencing factors is important.
Lupus Mortality Statistics
Lupus is associated with higher mortality rates compared to the general population. Studies indicate that individuals with lupus are approximately 2.4 to 4 times more likely to die than those without the disease. The standardized mortality ratio (SMR) for patients with lupus nephritis, a severe kidney complication, can be even higher, reaching 6.33.
The age-adjusted mortality rate (AAMR) for systemic lupus erythematosus in the United States decreased from 1 per 100,000 in 1999 to 0.78 per 100,000 in 2022. This represents a 21% decrease from 1999 to 2019. Despite these improvements, lupus remains a significant cause of premature death, considered among the top 20 leading causes of death for females aged 5 to 64 in the United States.
The median age of death for individuals with lupus is around 65.3 years. However, this figure can vary significantly across different demographic groups. For instance, Black individuals with lupus die at a mean age of approximately 51.8 to 52.3 years, notably younger than the 64.4 to 65.0 years observed for white individuals. Survival rates have improved, with 5-year survival increasing from about 50% in the 1950s to over 90% since the 1990s. Approximately 85% of lupus patients survive for 10 years, and about 75% survive for 20 years after diagnosis.
Primary Causes of Death in Lupus
Cardiovascular disease (CVD) is the leading cause of death in individuals with lupus, accounting for approximately 33% of all deaths. Lupus patients face a significantly elevated risk of various cardiovascular events, including heart attack, congestive heart failure, and cerebrovascular disease, with a 2 to 3-fold higher risk compared to the general population. The risk of heart attack can be as much as 7 to 9-fold higher for all lupus patients, and for women aged 35-44 with lupus, this risk can be 50 times greater.
Infections are the second leading cause of death in lupus patients. The disease compromises the immune system, and many treatments further suppress immune function, increasing susceptibility to severe infections. Early mortality in lupus is frequently associated with active disease and infections.
Kidney failure, particularly due to lupus nephritis, is another serious complication that can lead to death. Lupus nephritis involves inflammation of the kidneys, which can progress to end-stage renal disease (ESRD). Deaths from ESRD due to this condition have declined by 32% over the past two decades, with a 44% reduction in deaths from cardiovascular disease and a 63% reduction in deaths from infection among this subgroup. Other potential causes of death include pulmonary complications and severe central nervous system involvement.
Factors Influencing Mortality Rates
Several factors influence mortality rates in individuals with lupus. Disease severity at diagnosis plays a significant role, with higher initial disease severity correlating with an elevated risk of mortality. Maintaining low disease activity or achieving remission reduces the risk of death. The presence of specific autoantibodies, such as those associated with antiphospholipid syndrome, can also increase the risk of cardiac events and mortality.
Demographic factors like age, sex, and ethnicity also influence outcomes. Younger patients with lupus generally have higher standardized mortality ratios, but older age at diagnosis can predict reduced long-term survival. Women consistently exhibit higher age-adjusted mortality rates than men, though men experienced a greater proportional decrease from 1999 to 2019. Ethnicity introduces notable disparities; non-Hispanic African American patients generally have the highest age-adjusted mortality rates, and Black individuals experience significantly higher cumulative mortality and die younger than white individuals.
External factors, including socioeconomic status and access to healthcare, significantly impact mortality. Low socioeconomic status is consistently linked to worse outcomes and higher mortality rates. Poverty contributes to earlier deaths among individuals with lupus. Adherence to prescribed treatments, such as antimalarial therapy, is also a substantial factor, associated with a 71% to 83% lower risk of death. These disparities highlight how social inequities can contribute to differences in disease progression and outcomes.
Trends in Lupus Mortality
Mortality rates associated with lupus have shown a general decline over time, reflecting advancements in medical understanding and treatment. The age-adjusted mortality rate in the United States decreased by 21% from 1999 to 2019. This positive trend is largely attributed to improved diagnostic methods, more effective treatments, and better overall disease management. Early diagnosis and new therapies have improved long-term survival rates.
Despite this progress, recent data show a slight reversal in this trend. The age-adjusted mortality rate increased by 21.52% from 0.79 per 100,000 in 2019 to 0.96 per 100,000 in 2021. This increase might be influenced by the COVID-19 pandemic, as lupus patients who contracted COVID-19 faced a higher risk of death.
Persistent disparities in mortality rates remain a challenge. Certain groups continue to experience disproportionately higher mortality, including women, non-Hispanic African Americans, and individuals residing in the Southern United States. While cause-specific mortality from infections and cardiovascular disease among lupus nephritis patients has decreased, disparities persist.