title: National Lupus Hospitalization Trends Reveal Rising Rates of Herpes Zoster and Declines in Pneumocystis Pneumonia.
abstract: OBJECTIVE
  Infection is a leading cause of morbidity and mortality in systemic lupus erythematosus (SLE). Therapeutic practices have evolved over the past 15 years, but effects on infectious complications of SLE are unknown. We evaluated trends in hospitalizations for severe and opportunistic infections in a population-based SLE study.
  
  
  METHODS
  Data derive from the 2000 to 2011 United States National Inpatient Sample, including individuals who met a validated administrative definition of SLE. Primary outcomes were diagnoses of bacteremia, pneumonia, opportunistic fungal infection, herpes zoster, cytomegalovirus, or pneumocystis pneumonia (PCP). We used Poisson regression to determine whether infection rates were changing in SLE hospitalizations and used predictive marginals to generate annual adjusted rates of specific infections.
  
  
  RESULTS
  We identified 361,337 SLE hospitalizations from 2000 to 2011 meeting study inclusion criteria. Compared to non-SLE hospitalizations, SLE patients were younger (51 vs. 62 years), predominantly female (89% vs. 54%), and more likely to be racial/ethnic minorities. SLE diagnosis was significantly associated with all measured severe and opportunistic infections. From 2000 to 2011, adjusted SLE hospitalization rates for herpes zoster increased more than non-SLE rates: 54 to 79 per 10,000 SLE hospitalizations compared with 24 to 29 per 10,000 non-SLE hospitalizations. Conversely, SLE hospitalizations for PCP disproportionately decreased: 5.1 to 2.5 per 10,000 SLE hospitalizations compared with 0.9 to 1.3 per 10,000 non-SLE hospitalizations.
  
  
  CONCLUSIONS
  Among patients with SLE, herpes zoster hospitalizations are rising while PCP hospitalizations are declining. These trends likely reflect evolving SLE treatment strategies. Further research is needed to identify patients at greatest risk for infectious complications.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Sara G
authors.initials: SG
authors.lastname: Murray
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Department of Medicine, Veterans Administration, San Francisco, California, United States of America.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Lianne
authors.initials: L
authors.lastname: Gensler
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Yelin
authors.affiliation: Division of Oral Epidemiology and Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Gansky
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology; D015897:Comorbidity; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D006562:Herpes Zoster / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009181:Mycoses / Q000453:epidemiology; D009894:Opportunistic Infections / Q000453:epidemiology*; D011014:Pneumonia / Q000453:epidemiology; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology*; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055815:Young Adult