Epidemiology of Lupus: Longitudinal Studies in Population-Based Cohorts - 2022

项目总结 关于狼疮的知识偏向于疾病谱的严重端，因为难以组装 以人群为基础的狼疮患者队列。迫切需要扩大基础流行病学 对皮肤和系统性红斑狼疮在四个方面(即自然病史、治疗、健康)的了解 疾病控制和预防中心确定了医疗服务可获得性和差异)。我们的项目 使用罗切斯特流行病学项目(REP)独特的研究基础设施来满足这些需求， 其中包含明尼苏达州和威斯康星州27个县地区居民的纵向数据。我们有 由流行和发病系统性红斑狼疮患者组成的集合人群队列 红斑狼疮(SLE)和皮肤红斑狼疮(CLE)与普通人群比较 没有按性别、年龄、种族/民族和居住地划分的SLE/CLE。这些队列构成了狼疮 中西部网络(流明)。通过代表基础设施，Lumen跟踪个人，而不管 保险地位，涵盖从初级保健诊所到三级专科的全方位护理 护理，并维护诊断和程序的电子索引，包括所有住院和门诊患者 遭遇、实验室测量和药物处方数据。在这场竞争激烈的更新换代中取得了巨大的成功 格兰特研究SLE和CLE的多种疾病，阿片类止痛疗法，以及医疗保健渠道和差距，我们的 拥有数十年进行人口研究经验的研究人员和临床医生团队现在将 专注于新的研究问题，旨在对公共卫生产生高度影响，并在我们的 了解自然病史、治疗、医疗服务的可获得性，以及在所有领域的差距 CLE和SLE。使用基于管腔人群的队列，我们的目标是：1)确定狼疮的贡献 肾炎(LN)和抗磷脂综合征(APS)对过度死亡率和计划外保健的影响 SLE患者的利用情况(即急诊科就诊和住院)；2)确定 LN对心血管疾病(心肌梗死和中风)、感染、 以及系统性红斑狼疮患者的骨质疏松症；3)确定是否有机会获得针对系统性红斑狼疮的筛查服务 健康、年龄、性别和种族/民族的社会决定因素使用糖皮质激素的模式；以及4)决定 40年来从慢性肺病向系统性红斑狼疮过渡的时间转换率和风险因素 假设a)大多数从CLE到SLE的转变发生在CLE诊断后的五年内，以及b)口腔 避孕药或绝经后激素的使用会增加从慢性狼疮转变为系统性红斑狼疮的风险。这些 项目将为明确定义的疾病表型中系统性红斑狼疮的个体化预测提供信息，并 旨在优化患者护理、预防或减少狼疮患者不良后果的干预措施，并将 确定CLE的机会之窗，以进行治疗干预以预防向SLE的过渡。

PROJECT SUMMARY Knowledge about lupus is biased towards the severe end of the disease spectrum due to difficulty assembling population-based cohorts of persons with lupus. An urgent need to expand the basic epidemiologic understanding of cutaneous and systemic lupus in four content areas (i.e., natural history, treatment, health care access, and disparities) was identified by the Centers for Disease Control and Prevention. Our project addresses these needs using the unique research infrastructure of the Rochester Epidemiology Project (REP), which contains longitudinal data on residents of a 27-county region in Minnesota and Wisconsin. We have assembled population-based cohorts comprised of persons with prevalent and incidence systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE) matched to general population comparators without SLE/CLE by sex, age, race/ethnicity, and county of residence. These cohorts comprise the Lupus Midwest Network (LUMEN). Through the REP infrastructure, LUMEN follows individuals regardless of insurance status and encompasses the full spectrum of care, from primary care clinics to tertiary specialty care, and maintains an electronic index of diagnoses and procedures, including all inpatient and outpatient encounters, laboratory measures, and drug prescription data. In this competitive renewal of a highly successful grant investigating multimorbidity in SLE and CLE, opioid pain therapy, and healthcare access and gaps, our team of researchers and clinicians with decades of experience conducting population-based research will now focus on new research questions designed to have a high public health impact and to leap forward in our understanding of the natural history, treatment, healthcare access, and disparities across the full spectrum of CLE and SLE. Using the LUMEN population-based cohorts, we aim to 1) determine the contributions of lupus nephritis (LN) and anti-phospholipid syndrome (APS) to the excess mortality and unplanned healthcare utilization (i.e., emergency department visits and hospitalizations) among patients with SLE; 2) determine the contribution of LN to the excess risk of cardiovascular disease (myocardial infarction and stroke), infections, and osteoporosis among patients with SLE; 3) determine access to SLE-specific screening services and patterns of glucocorticoid use by social determinants of health, age, sex, and race/ethnicity; and 4) determine the transition rates over time and risk factors for transition from CLE to SLE over four decades to test the hypothesis that a) most transitions from CLE to SLE occur within five years of the CLE diagnosis, and b) oral contraceptives or postmenopausal hormone use increase the risk of transitioning from CLE to SLE. These projects will inform the individualized prognostication of SLE in clearly defined disease phenotypes and inform interventions to optimize patient care, prevent or reduce adverse outcomes in patients with lupus, and will identify a window of opportunity in CLE for therapeutic interventions to prevent the transition to SLE.