title: Mortality profile related to systemic lupus erythematosus: a multiple cause-of-death analysis.
abstract: OBJECTIVE
  To analyze the mortality profile related to systemic lupus erythematosus (SLE) in the state of São Paulo, Brazil.
  
  
  METHODS
  For the 1985-2007 period, we analyzed all death certificates (n = 4815) on which SLE was listed as an underlying (n = 3133) or non-underlying (n = 1682) cause of death. We evaluated sex, age, and the causes of death, comparing the first and last 5 years of the period, as well as determining the observed/expected death ratio (O/E ratio).
  
  
  RESULTS
  For SLE as an underlying cause, the mean age at death was 35.77 years (SD 15.12) and the main non-underlying causes of death were renal failure, circulatory system diseases, pneumonia, and septicemia. Over the period, the proportional mention of infectious causes and circulatory system diseases increased, whereas renal diseases decreased. For SLE as a non-underlying cause of death, the most common underlying causes of death were circulatory, respiratory, genitourinary, and digestive system diseases, and certain infections. The overall death O/E ratio was > 1 for renal failure, tuberculosis, septicemia, pneumonia, and digestive system diseases, as well as for circulatory system diseases at < 50 years of age, particularly acute myocardial infarct.
  
  
  CONCLUSIONS
  Unlike in developed countries, renal failure and infectious diseases are still the most frequent causes of death. The increase in SLE deaths associated with infection, especially pneumonia and septicemia, is worrisome. The judicious use of immunosuppressive therapy together with vigorous treatment of cardiovascular comorbidities is crucial to the successful management of SLE and to improving survival of patients with SLE.
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Deborah C C
authors.initials: DC
authors.lastname: Souza
authors.forename: Augusto H
authors.initials: AH
authors.lastname: Santo
authors.forename: Emilia I
authors.initials: EI
authors.lastname: Sato
mesh_terms: D000328:Adult; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D002423:Cause of Death / Q000639:trends*; D015897:Comorbidity; D004066:Digestive System Diseases / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000401:mortality*; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000401:mortality*; D012737:Sex Factors; D015996:Survival Rate