Race, Ethnicity, and Disparities in the Risk of End‐Organ Lupus Manifestations Following a Systemic Lupus Erythematosus Diagnosis in a Multiethnic Cohort

Abstract

Data on onset of lupus manifestations across multiple organ domains and in diverse populations is limited. We analyzed racial and ethnic differences in risk of end-organ lupus manifestations following systemic lupus erythematosus (SLE) diagnosis in a multiethnic cohort. The California Lupus Epidemiology Study (CLUES) is a longitudinal study of SLE. Data on major end-organ lupus manifestations were collected and categorized by organ system: renal, hematologic, neurologic, cardiovascular, and pulmonary. Multiorgan disease was defined as manifestations in ≥2 of these distinct organ systems. Kaplan-Meier curves assessed end-organ disease-free survival, and Cox proportional hazard regression estimated the rate of end-organ disease following SLE diagnosis adjusting for age at diagnosis, sex, and self-reported race and ethnicity (White, Hispanic, Black, and Asian). Of 326 participants, 89% were female and had a mean age and age at diagnosis of 45 and 29 years, respectively. Self-reported race and ethnicity was 30% White, 23% Hispanic, 11% Black, and 36% Asian. Multiorgan disease occurred in 29%. Compared to White participants, Hispanic and Asian participants had higher rates of renal (HR 2.9 [95% CI 1.8–4.7], HR 2.9 [95% CI 1.9–4.6]), hematologic (HR 2.7 [95% CI 1.3–5.7], HR 2.1 [95% CI 1.0–4.2]), and multiorgan disease (HR 3.3 [95% CI 1.8–5.9], HR 2.5 [95% CI 1.4–4.4]) following SLE diagnosis. We found heightened risks of developing renal, hematologic, and multiorgan disease following SLE diagnosis among Hispanic and Asian patients with SLE, as well as a high burden of multiorgan disease among CLUES participants.