OA07 The incidence, mortality and complications of systemic lupus erythematosus: a population-level cohort study from 2012 to 2023

Abstract Background/Aims Ethnicity-related inequalities in the epidemiology of systemic lupus erythematosus (SLE) have been consistently described, yet robust population-level data remain limited. We aimed to characterise the incidence, all-cause mortality, and complications of SLE in a contemporary, ethnically diverse, nationwide cohort. Methods We conducted a population-level study using the Clinical Practice Research Datalink in England. Individuals aged ≥18 years with new SLE diagnoses between 2012 and 2023 were included. Age and sex-matched controls were selected in a 4:1 ratio. Studied complications were based on the Systemic Lupus International Collaborating Clinics (SLICC) damage index and included ischaemic heart disease, heart failure, stroke or transient ischaemic attacks (TIA), thrombosis (arterial or venous), myocarditis or pericarditis, diabetes mellitus, chronic kidney disease (CKD), interstitial lung disease (ILD), osteoporosis, fractures, and cancer; fibromyalgia was additionally examined given its clinical relevance. Standardised rates for incidence, complications and mortality were determined by applying direct age and sex-standardisation to the 2013 European Standard Population. Risk of death and complications were estimated using flexible parametric and competing risk models, respectively. Results The cohort consisted of 4,937 incident SLE diagnoses (87.9% female; median age 47). The incidence of SLE declined over the study period across all ethnicities. Compared with controls (N = 19,707), patients with SLE had higher all-cause mortality (HR 2.06, 95% CI 1.84-2.32) and elevated risk of all studied complications except cancer (Table 1). Black ethnic groups had the highest incidence of SLE (Black Caribbean incidence in 2023: 11.07 per 100,000 person-years, 95% CI 6.05-18.58) and mortality risk (HR 1.64, 95% CI 1.05-2.55), with increased risks of diabetes, myocarditis/pericarditis, and interstitial lung disease compared with White ethnic groups (Table 1). Conclusion This is the first population-level description of SLE mortality and complications by ethnicity outside of the USA. Despite declining incidence, mortality for people with SLE was twice that of controls in this large contemporaneous incident cohort. Stark ethnicity-based inequalities were revealed, with elevated mortality and morbidity risk in Black ethnic groups with SLE compared with White ethnic groups. These findings call for urgent acknowledgement and action to address these ongoing inequities. Disclosure S. Patel: None. M. Russell: Honoraria; AbbVie, Lilly, Galapagos, Menarini, UCB and Vifor Pharma. Grants/research support; Sandoz UK. K. Bechman: None. C. Wincup: Honoraria; AstraZeneca, AbbVie, Bristol Myers Squibb, CSL Vifor, Kyverna, Otsuka, UCB. Grants/research support; AstraZeneca. M. Adas: None. D. Nagra: None. A. Dregan: None. E. Alveyn: None. K. Bramham: Honoraria; AstraZeneca, Vertex, GSK, Otsuka and Boehringer Ingelheim. Grants/research support; AstraZeneca. S. Norton: None. J. Galloway: Honoraria; Abbvie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB. Grants/research support; Sandoz UK. P. Gordon: None.