Prevalence of Systemic Lupus Erythematosus in the United States: Estimates From a Meta-Analysis of the Centers for Disease Control and Prevention National Lupus Registries

Abstract

Objective: Epidemiologic data on systemic lupus erythematosus (SLE) are limited, particularly for racial/ethnic subpopulations in the US. This meta-analysis leveraged data from the Centers for Disease Control and Prevention (CDC) National Lupus Registry network of population-based SLE registries to estimate the overall prevalence of SLE in the US.

Methods: The CDC National Lupus Registry network includes 4 registries from unique states and a fifth registry from the Indian Health Service. All registries defined cases of SLE according to the American College of Rheumatology (ACR) 1997 revised classification criteria for SLE. Case findings spanned either 2002-2004 or 2007-2009. Given the heterogeneity across sites, a random-effects model was used to calculate the pooled prevalence of SLE. An estimate of the number of SLE cases in the US was generated by applying sex/race-stratified estimates to the 2018 US Census population.

Results: In total, 5,417 cases were identified as fulfilling the ACR SLE classification criteria. The pooled prevalence of SLE from the 4 state-specific registries was 72.8 per 100,000 person-years (95% confidence interval [95% CI] 65.3-81.0). The prevalence estimate was 9 times higher among females than among males (128.7 versus 14.6 per 100,000), and highest among Black females (230.9 per 100,000), followed by Hispanic females (120.7 per 100,000), White females (84.7 per 100,000), and Asian/Pacific Islander females (84.4 per 100,000). Among males, the prevalence of SLE was highest in Black males (26.7 per 100,000), followed by Hispanic males (18.0 per 100,000), Asian/Pacific Islander males (11.2 per 100,000), and White males (8.9 per 100,000). The American Indian/Alaska Native population had the highest race-specific SLE estimates, both among females (270.6 per 100,000) and among males (53.8 per 100,000). In 2018, an estimated 204,295 individuals (95% CI 160,902-261,725) in the US fulfilled the ACR classification criteria for SLE.

Conclusion: A coordinated network of population-based SLE registries provides more accurate estimates of the prevalence of SLE and the numbers of individuals affected with SLE in the US in 2018.

Figure 1

A: Meta-Analysis Results of SLE Prevalence Based on Four CDC Population-Based Registries, Overall and by Registry Site. Overall prevalence estimates for the SLE registry sites in Michigan (MI), Georgia (GA), New York (NY), and California (CA) are represented by circles, with the size of the circle corresponding to the weight of the contribution to the meta-analysis, and the diamond representing the results from the meta-analysis and the lines corresponding to 95% confidence intervals. B & C: Meta-Analysis Results of SLE Prevalence Based on Four CDC Population-Based Registries, Overall and by Race and Hispanic Ethnicity Among Females (B) and Males (C) The overall female and male meta-analysis estimate is based on results from the lupus registry sites in Michigan, Georgia, New York, and California. ^a Estimates for Blacks and whites are based on pooled estimates from the four state-based registries; Asian/Pacific Islanders (Asian/PI) are based on pooled estimates from Michigan, California and New York; American Indian/Alaska Native (AI/AN) estimates are from the Indian Health Service registry data previously published. ^b Estimates for Hispanics are based on pooled estimates from Michigan, California and New York. Systemic lupus erythematosus (SLE) cases were defined according to the American College of Rheumatology (ACR) criteria.