Longitudinal trends in vaccination uptake and respiratory infection burden in systemic lupus erythematosus: a population-based cohort study

OBJECTIVES: To evaluate longitudinal patterns of vaccination uptake and respiratory infection outcomes among patients with systemic lupus erythematosus (SLE) compared with controls and identify factors associated with vaccination uptake. METHODS: Population-based cohort study using a healthcare organization database. Adult patients with SLE (diagnosed 2010-2023) were identified through a validated registry and matched 1:100 to controls by birth year, sex, and socioeconomic status. Vaccination uptake for influenza, pneumococcal, and COVID-19 vaccines, respiratory infections, hospitalizations, intensive care unit (ICU) admissions, and mortality were evaluated. Temporal trends and factors associated with vaccination uptake were assessed using multivariable models. RESULTS: The study included 3,692 patients with SLE and 382,753 matched controls (median follow-ups 12.8 and 13.4 years, respectively). Vaccination uptake was higher among patients with SLE than controls (influenza: 77.6% vs. 56.4%; pneumococcal: 55.6% vs. 32.1%; COVID-19: 74.2% vs. 72.0%; all p < 0.01). Patients with SLE experienced higher rates of respiratory hospitalization (34.8% vs. 11.5%), pneumonia hospitalization (23.9% vs. 5.9%), ICU admission (12.8% vs. 2.7%), and all-cause mortality (21.0% vs. 8.5%) (all p < 0.001). Longitudinally, vaccination uptake and respiratory hospitalizations remained consistently higher among patients with SLE. Pneumonia hospitalization rates increased over time in controls but remained stable in SLE (interaction p = 0.020). Older age, more comorbidities, higher socioeconomic status, and exposure to glucocorticoids were independently associated with influenza and pneumococcal vaccination uptake rates in SLE. CONCLUSION: Patients with SLE demonstrated substantially higher vaccine exposure than controls but experienced elevated respiratory infection rates and severe outcomes. These findings support efforts to optimize infection prevention strategies in SLE.