title: Mortality in systemic lupus erythematosus.
abstract: OBJECTIVE
  To examine mortality rates in the largest systemic lupus erythematosus (SLE) cohort ever assembled.
  
  
  METHODS
  Our sample was a multisite international SLE cohort (23 centers, 9,547 patients). Deaths were ascertained by vital statistics registry linkage. Standardized mortality ratio (SMR; ratio of deaths observed to deaths expected) estimates were calculated for all deaths and by cause. The effects of sex, age, SLE duration, race, and calendar-year periods were determined.
  
  
  RESULTS
  The overall SMR was 2.4 (95% confidence interval 2.3-2.5). Particularly high mortality was seen for circulatory disease, infections, renal disease, non-Hodgkin's lymphoma, and lung cancer. The highest SMR estimates were seen in patient groups characterized by female sex, younger age, SLE duration <1 year, or black/African American race. There was a dramatic decrease in total SMR estimates across calendar-year periods, which was demonstrable for specific causes including death due to infections and death due to renal disorders. However, the SMR due to circulatory diseases tended to increase slightly from the 1970s to the year 2001.
  
  
  CONCLUSIONS
  Our data from a very large multicenter international cohort emphasize what has been demonstrated previously in smaller samples. These results highlight the increased mortality rate in SLE patients compared with the general population, and they suggest particular risk associated with female sex, younger age, shorter SLE duration, and black/African American race. The risk for certain types of deaths, primarily related to lupus activity (such as renal disease), has decreased over time, while the risk for deaths due to circulatory disease does not appear to have diminished.
authors.affiliation: Montreal General Hospital, Montreal, Quebec, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Bernatsky
authors.forename: J-F
authors.initials: JF
authors.lastname: Boivin
authors.forename: L
authors.initials: L
authors.lastname: Joseph
authors.forename: S
authors.initials: S
authors.lastname: Manzi
authors.forename: E
authors.initials: E
authors.lastname: Ginzler
authors.forename: D D
authors.initials: DD
authors.lastname: Gladman
authors.forename: M
authors.initials: M
authors.lastname: Urowitz
authors.forename: P R
authors.initials: PR
authors.lastname: Fortin
authors.forename: M
authors.initials: M
authors.lastname: Petri
authors.forename: S
authors.initials: S
authors.lastname: Barr
authors.forename: C
authors.initials: C
authors.lastname: Gordon
authors.forename: S-C
authors.initials: SC
authors.lastname: Bae
authors.forename: D
authors.initials: D
authors.lastname: Isenberg
authors.forename: A
authors.initials: A
authors.lastname: Zoma
authors.forename: C
authors.initials: C
authors.lastname: Aranow
authors.forename: M-A
authors.initials: MA
authors.lastname: Dooley
authors.forename: O
authors.initials: O
authors.lastname: Nived
authors.forename: G
authors.initials: G
authors.lastname: Sturfelt
authors.forename: K
authors.initials: K
authors.lastname: Steinsson
authors.forename: G
authors.initials: G
authors.lastname: Alarcón
authors.forename: J-L
authors.initials: JL
authors.lastname: Senécal
authors.forename: M
authors.initials: M
authors.lastname: Zummer
authors.forename: J
authors.initials: J
authors.lastname: Hanly
authors.forename: S
authors.initials: S
authors.lastname: Ensworth
authors.forename: J
authors.initials: J
authors.lastname: Pope
authors.forename: S
authors.initials: S
authors.lastname: Edworthy
authors.forename: A
authors.initials: A
authors.lastname: Rahman
authors.forename: J
authors.initials: J
authors.lastname: Sibley
authors.forename: H
authors.initials: H
authors.lastname: El-Gabalawy
authors.forename: T
authors.initials: T
authors.lastname: McCarthy
authors.forename: Y
authors.initials: Y
authors.lastname: St Pierre
authors.forename: A
authors.initials: A
authors.lastname: Clarke
authors.forename: R
authors.initials: R
authors.lastname: Ramsey-Goldman
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D007391:International Cooperation; D007723:Korea / Q000453:epidemiology; D008180:Lupus Erythematosus, Systemic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D012042:Registries; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology