A CDC WONDER Study on Disparities in Place of Death Among Patients With Systemic Lupus Erythematosus in the United States between 1999 and 2020

Systemic lupus erythematosus (SLE) is an autoimmune disease, more prevalent among African-American women, often associated with severe manifestations such as lupus nephritis and neuropsychiatric lupus. Both conditions contribute significantly to morbidity and mortality, though lupus nephritis is more commonly linked to direct disease-related deaths. Mortality can also result from other severe disease manifestations or treatment-related complications. Assessing disparities in place of death among lupus patients is essential for improving care quality through targeted physician and patient education. The aim of this study is to evaluate disparities in the place of death (hospital, nursing home, hospice, and home) among lupus patients in the United States of America (USA), based on demographic characteristics like age, gender, race, and geographic regions. A retrospective study was conducted in September 2023 using Centers for Disease Control and Prevention - Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data, focused on deaths attributed to lupus erythematosus (International Classification of Diseases, Tenth Revision (ICD-10) Code: L93, including L93.0, L93.1, and L93.2). It analyzed disparities in death location (home/hospice, medical facility/nursing home, others that include unknown locations or unspecified categories where the place of death could not be conclusively determined) across four variables employing statistical tools STATA15 (StataCorp LLC, College Station, TX) and R3.6.3 (The R Core Team, R Foundation for Statistical Computing, Vienna, Austria). A total of 3,937 deaths from 1999 to 2020 were included in the analysis from the CDC WONDER database, which showed 1,269 deaths were in home/hospice, 2,517 in medical/nursing facilities, and 151 at other unknown/unspecified locations. Higher odds of home/hospice deaths were noted in ages 55-64 years (1.606) and 65-74 years (1.576), males (1.306 times more than females), patients who were American Indian/Alaska Native (3.447), and those in Census region 3: South (1.459). Lupus patients above 50 years, males, and those of American Indian/Alaskan race, and from the Census region 3 (South) have an increased likelihood of dying in home/hospice care. Future predictions till 2025 using the AutoRegressive Integrated Moving Average (ARIMA) model indicate an increasing trend of cumulative home/hospice mortality.