Racial and Ethnic Differences in the Prevalence and Time to Onset of Manifestations of Systemic Lupus Erythematosus: The California Lupus Surveillance Project
Racial and Ethnic Differences in the Prevalence and Time to Onset of Manifestations of Systemic Lupus Erythematosus: The California Lupus Surveillance Project
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DOI：
10.1002/acr.23887
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发表时间：
2020-05-01
影响因子：
4.7
通讯作者：
Yazdany, Jinoos
中科院分区：
文献类型：
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作者：
Maningding, Ernest;Dall'Era, Maria;Yazdany, Jinoos
目的加州狼疮监测项目（CLSP）是一项以人群为基础的系统性红斑狼疮（SLE）患者登记研究，对象为2007 - 2009年居住在美国加州弗朗西斯科县的亚洲/太平洋岛民和西班牙裔患者。我们采用回顾性CLSP数据，分析种族和种族的差异，狼疮表现和发展严重的increasing.Methods的时间和风险共724例SLE患者进行了回顾性鉴定。使用Poisson回归模型计算SLE表现的患病率（PR），按人种/种族分层，并根据性别、SLE诊断时的年龄和疾病持续时间进行调整。我们采用Kaplan-Meier方法研究了SLE诊断后发生的严重SLE表现，以检查至事件发生的时间，并采用考克斯比例风险回归模型估计风险比（HR）。结果非裔美国人、亚洲/太平洋岛民和西班牙裔患者肾脏表现的患病率增加（分别为PR 1.74 [95%可信区间（95%CI）1.40-2.16]、PR 1.68 [95%CI 1.38-2.05]和PR 1.35 [95%CI 1.05-1.74]）。此外，非裔美国人的神经系统表现的患病率增加（PR 1.49 [95% CI 1.12-1.98]），非裔美国人（PR 1.09 [95% CI 1.04-1.15]）和亚洲/太平洋岛民（PR 1.07 [95% CI 1.01-1.13]）的血液学表现的患病率增加。非裔美国人、亚洲/太平洋岛民和西班牙裔患者分别有更高的发生狼疮性肾炎的风险（HR 2.4 [95% CI 1.6-3.8]、HR 4.3 [95% CI 2.9-6.4]和HR 2.3 [95% CI 1.4-3.8]）和血小板减少症（HR 2.3 [95% CI 1.1-4.4]、HR 2.3 [95% CI 1.3-4.2]和HR 2.2 [95% CI 1.1-4.7]）。亚洲/太平洋岛民和西班牙裔患者发生抗磷脂综合征的风险较高（HR分别为2.5 [95%CI 1.4-4.4]和2.6 [95%CI 1.3-5.1]）。我们发现不同种族/民族之间几种SLE临床表现的患病率存在显着差异，并发现非裔美国人、亚洲/太平洋岛民和西班牙裔患者在诊断出SLE后出现几种严重表现的风险增加。
Objective The California Lupus Surveillance Project (CLSP) is a population-based registry of individuals with systemic lupus erythematosus (SLE) residing in San Francisco County, California from 2007 to 2009, with a special focus on Asian/Pacific Islander and Hispanic patients. We used retrospective CLSP data to analyze racial and ethnic differences in lupus manifestations and in the timing and risk of developing severe manifestations.Methods A total of 724 patients with SLE were retrospectively identified. Prevalence ratios (PRs) of SLE manifestations were calculated using Poisson regression models stratified by race/ethnicity and adjusted for sex, age at SLE diagnosis, and disease duration. We studied onset of severe SLE manifestations after SLE diagnosis using Kaplan-Meier methods to examine time-to-event and Cox proportional hazards regression models to estimate hazard ratios (HRs). White patients were the referent group in all analyses.Results African Americans, Asian/Pacific Islanders, and Hispanic patients had increased prevalence of renal manifestations (PR 1.74 [95% confidence interval (95% CI) 1.40-2.16], PR 1.68 [95% CI 1.38-2.05], and PR 1.35 [95% CI 1.05-1.74], respectively). Furthermore, African Americans had increased prevalence of neurologic manifestations (PR 1.49 [95% CI 1.12-1.98]), and both African Americans (PR 1.09 [95% CI 1.04-1.15]) and Asian/Pacific Islanders (PR 1.07 [95% CI 1.01-1.13]) had increased prevalence of hematologic manifestations. African Americans, Asian/Pacific Islanders, and Hispanic patients, respectively, had higher risk of developing lupus nephritis (HR 2.4 [95% CI 1.6-3.8], HR 4.3 [95% CI 2.9-6.4], and HR 2.3 [95% CI 1.4-3.8]) and thrombocytopenia (HR 2.3 [95% CI 1.1-4.4], HR 2.3 [95% CI 1.3-4.2], and HR 2.2 [95% CI 1.1-4.7]). Asian/Pacific Islander and Hispanic patients had higher risk of developing antiphospholipid syndrome (HR 2.5 [95% CI 1.4-4.4] and HR 2.6 [95% CI 1.3-5.1], respectively).Conclusion This is the first epidemiologic study comparing lupus manifestations among 4 major racial and ethnic groups. We found substantial differences in the prevalence of several clinical SLE manifestations among racial/ethnic groups and discovered that African Americans, Asian/Pacific Islanders, and Hispanic patients are at increased risk of developing several severe manifestations following a diagnosis of SLE.