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The global burden of SLE: prevalence, health disparities and socioeconomic impact

Key Points

  • Worldwide incidence and prevalence estimates of systemic lupus erythematosus (SLE) vary substantially and are influenced by ethnic and geographic differences, study design and environmental exposures

  • Disease severity is greater in African American populations than in white populations

  • Poverty, low educational attainment, lack of health insurance, poor social support and poor treatment compliance are all associated with unfavourable disease outcomes, both independent of, and in combination with, ethnic influences

  • The treatment of SLE incurs high direct costs, and sometimes even higher indirect costs; costs are influenced by disease severity and organ manifestations

  • Health-related quality of life is greatly compromised in patients with SLE

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can potentially lead to serious organ complications and even death. Its global burden — in terms of incidence and prevalence, differential impact on populations, economic costs and capacity to compromise health-related quality of life — remains incompletely understood. The reported worldwide incidence and prevalence of SLE vary considerably; this variation is probably attributable to a variety of factors, including ethnic and geographic differences in the populations being studied, the definition of SLE applied, and the methods of case identification. Despite the heterogeneous nature of the disease, distinct patterns of disease presentation, severity and course can often be related to differences in ethnicity, income level, education, health insurance status, level of social support and medication compliance, as well as environmental and occupational factors. Given the potential for the disease to cause such severe and widespread organ damage, not only are the attendant direct costs high, but these costs are sometimes exceeded by indirect costs owing to loss of economic productivity. As an intangible cost, patients with SLE are, not surprisingly, likely to endure considerably reduced health-related quality of life.

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Figure 1: Overall worldwide prevalence ranges for SLE.
Figure 2: Worldwide female prevalence ranges for SLE.
Figure 3: Worldwide male prevalence ranges for SLE.

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A.E.C. and E.E.C. researched data for the article, contributed substantially to discussions of its content, and wrote the manuscript. All authors (A.E.C., E.E.C and S.G.B) undertook review and editing of the manuscript before submission.

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A.A.C. declares that she has served as a consultant for Astra-Zeneca, Bristol–Myers Squibb and Eli Lilly. The other authors declare no competing interests.

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Carter, E., Barr, S. & Clarke, A. The global burden of SLE: prevalence, health disparities and socioeconomic impact. Nat Rev Rheumatol 12, 605–620 (2016). https://doi.org/10.1038/nrrheum.2016.137

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