Background: Lupus outcome differs by race/ethnicity in the United States. This study investigates the influence of residing in specific neighborhoods, defined by the rural-urban continuum codes (RUCC), on the odds of lupus-related deaths compared to deaths from other causes. Objectives: The study aims to evaluate lupus death odds by RUCC, comparing them to two control groups (accidental deaths and all-cause deaths), while adjusting for sex, race/ethnicity, and age groups. Methods: Using the individual mortality dataset from the Centers for Disease Control and Prevention, the analysis included all (>99%) United States deaths from 2011 through 2015. The primary outcome is lupus death identified from ICD 10 codes (M321, M328, M329). The primary exposure is the RUCC (metropolitan, non-metro urbanized, less urbanized, thinly populated) identified at the time of death. A multivariate logistic regression model is constructed, adjusting for covariates such as sex, ethnicity/race, and age. Potential effect modifiers between RUCC and other demographic variables are also examined. Results: From 2011 to 2015, there were 10,153 lupus deaths, 853,949 accidental deaths, and 13,018,527 all-cause deaths in the United States. Findings reveal lower adjusted odds of lupus vs. accident deaths in less urbanized (odds ratio 0.839 [95% CI 0.779 to 0.905], p<0.0001), thinly populated (0.803 [0.686-0.941], p=0.007), and non-metro urbanized areas (0.931 [0.857-1.012], p=0.09 [NS]) compared to metro-urbanized areas. Additionally, males (0.102 [0.096-0.108; p<0.0001]) exhibit lower odds than females, while non-Hispanic blacks (5.159 [4.918-5.412], p<0.0001), Hispanics (3.067 [2.877-3.270], p<0.0001), and non-Hispanic others (2.642 [2.401-2.907], p<0.0001) have higher odds compared to non-Hispanic Whites. Interaction between race/ethnicity and RUCC significantly influences lupus death risk. In the analysis for different subgroups, Hispanics had lower odds of lupus vs. accidental death in less urbanized (0.545 [0.389-0.763, p<0.0001) and non-metro urbanized areas (0.712 [0.517-0.982, p=0.04), but not in thinly populated areas, compared to metro-urbanized areas. Non-Hispanic blacks showed lower odds in less urbanized areas (0.732 [0.615-0.871, p<0.0001), but not in non-metro urbanized and thinly populated areas, relative to metro-urbanized areas. Non-Hispanic others had lower odds in all areas (non-metro urbanized, 0.509, p 0.001; less urbanized, 0.531, p<0.001; thinly populated, 0.569, p=0.06) than in metro-urbanized areas. The odds of lupus vs. all-cause deaths were lower in less urbanized areas (0.914 [95% CI 0.849-0.984], p=0.02) but not in thinly populated and non-metro urbanized areas. Non-Hispanic blacks showed lower odds of lupus vs. all-cause deaths in less urbanized areas (0.776 [0.656-0.918], p=0.003), but this trend was not statistically significant in other race/ethnic groups. Non-Hispanic blacks also had significantly lower odds of lupus vs. all-cause deaths in 45-64 years (0.454 [0.419-0.492], p<0.0001) and ≥65 years (0.088 [0.079-0.097], p <0.0001) than in <45-year group. Conclusion: The study identifies a significant association between rural-urban residence and lupus mortality, highlighting protective effects in less urbanized areas. Stratified analysis emphasizes pronounced benefits for Hispanic ethnicity and non-Hispanic black race/ethnicity in the less urbanized areas. Further research is needed to understand the reasons behind higher lupus deaths in metro-urbanized areas, particularly within Hispanic and non-Hispanic black communities. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.
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