Association of race and ethnicity with mortality in adults with SLE: a systematic literature review and meta-analysis
Objectives Ethnicity and health outcomes are intrinsically interrelated, although mechanisms are complex. SLE is a disease with higher incidence in Asian, Black, Hispanic and Indigenous populations than in White populations. SLE is associated with premature mortality, but it is unclear if ethnicity...
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BMJ Publishing Group
2025-02-01
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| Series: | Lupus Science and Medicine |
| Online Access: | https://lupus.bmj.com/content/12/1/e001383.full |
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| author | Sam Norton Chris Wincup Patrick Gordon Kate Bramham James Galloway Zijing Yang Samir Patel Maryam Adas Deepak Nagra Mark Russell |
| author_facet | Sam Norton Chris Wincup Patrick Gordon Kate Bramham James Galloway Zijing Yang Samir Patel Maryam Adas Deepak Nagra Mark Russell |
| author_sort | Sam Norton |
| collection | DOAJ |
| description | Objectives Ethnicity and health outcomes are intrinsically interrelated, although mechanisms are complex. SLE is a disease with higher incidence in Asian, Black, Hispanic and Indigenous populations than in White populations. SLE is associated with premature mortality, but it is unclear if ethnicity impacts on health outcomes as studies are frequently underpowered. We aimed to describe the association between SLE and mortality across different racial and ethnic groups using meta-analysis.Methods We identified studies of adults with SLE that reported mortality, stratified by racial and ethnic group, through a systematic literature review. We used a pairwise meta-analysis to determine the pooled odds ratio (OR) of death for those from underserved groups compared with those of White race and ethnicity.Results Thirty-seven studies, comprising 85 578 patients with SLE, were included. Mortality was higher in Black patients (OR 1.30 (95% CI 1.16 to 1.46)) and Indigenous patients (OR 1.47 (95% CI 1.11 to 1.94)), while Asian and Hispanic patients showed no significant differences compared with White patients with SLE. Seventy per cent of included studies were conducted in the USA and when excluded, the significant difference in mortality between Black and White individuals with SLE was no longer seen (OR 0.84 (95% CI 0.54 to 1.31)).Conclusion Overall, patients with SLE from Black or Indigenous racial and ethnic groups had higher mortality than those of White race and ethnicity. We observed no significant association in the mortality of Black patients compared with White patients from non-USA cohorts, but a scarcity of data outside of the USA was highlighted. We promote caution in the use of race and ethnicity as a factor in determining mortality risk until more generalisable data are available.PROSPERO registration number CRD42023379034. |
| format | Article |
| id | doaj-art-139bade23bcc4059a3ae721d320ac466 |
| institution | Kabale University |
| issn | 2053-8790 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Lupus Science and Medicine |
| spelling | doaj-art-139bade23bcc4059a3ae721d320ac4662025-02-11T18:15:14ZengBMJ Publishing GroupLupus Science and Medicine2053-87902025-02-0112110.1136/lupus-2024-001383Association of race and ethnicity with mortality in adults with SLE: a systematic literature review and meta-analysisSam Norton0Chris Wincup1Patrick Gordon2Kate Bramham3James Galloway4Zijing Yang5Samir Patel6Maryam Adas7Deepak Nagra8Mark Russell9Health Psychology, King`s College London Department of Psychology, London, UK2University College London, Rheumatology, London, United Kingdom2 Department of Rheumatology, King`s College Hospital, London, UKconsultant nephrologistKing`s College London, London, UK2 Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, ChinaDivision of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, CanadaCentre for Rheumatic Diseases, King`s College London Faculty of Life Sciences & Medicine, London, UKKing`s College London, London, UKKing`s College London, London, UKObjectives Ethnicity and health outcomes are intrinsically interrelated, although mechanisms are complex. SLE is a disease with higher incidence in Asian, Black, Hispanic and Indigenous populations than in White populations. SLE is associated with premature mortality, but it is unclear if ethnicity impacts on health outcomes as studies are frequently underpowered. We aimed to describe the association between SLE and mortality across different racial and ethnic groups using meta-analysis.Methods We identified studies of adults with SLE that reported mortality, stratified by racial and ethnic group, through a systematic literature review. We used a pairwise meta-analysis to determine the pooled odds ratio (OR) of death for those from underserved groups compared with those of White race and ethnicity.Results Thirty-seven studies, comprising 85 578 patients with SLE, were included. Mortality was higher in Black patients (OR 1.30 (95% CI 1.16 to 1.46)) and Indigenous patients (OR 1.47 (95% CI 1.11 to 1.94)), while Asian and Hispanic patients showed no significant differences compared with White patients with SLE. Seventy per cent of included studies were conducted in the USA and when excluded, the significant difference in mortality between Black and White individuals with SLE was no longer seen (OR 0.84 (95% CI 0.54 to 1.31)).Conclusion Overall, patients with SLE from Black or Indigenous racial and ethnic groups had higher mortality than those of White race and ethnicity. We observed no significant association in the mortality of Black patients compared with White patients from non-USA cohorts, but a scarcity of data outside of the USA was highlighted. We promote caution in the use of race and ethnicity as a factor in determining mortality risk until more generalisable data are available.PROSPERO registration number CRD42023379034.https://lupus.bmj.com/content/12/1/e001383.full |
| spellingShingle | Sam Norton Chris Wincup Patrick Gordon Kate Bramham James Galloway Zijing Yang Samir Patel Maryam Adas Deepak Nagra Mark Russell Association of race and ethnicity with mortality in adults with SLE: a systematic literature review and meta-analysis Lupus Science and Medicine |
| title | Association of race and ethnicity with mortality in adults with SLE: a systematic literature review and meta-analysis |
| title_full | Association of race and ethnicity with mortality in adults with SLE: a systematic literature review and meta-analysis |
| title_fullStr | Association of race and ethnicity with mortality in adults with SLE: a systematic literature review and meta-analysis |
| title_full_unstemmed | Association of race and ethnicity with mortality in adults with SLE: a systematic literature review and meta-analysis |
| title_short | Association of race and ethnicity with mortality in adults with SLE: a systematic literature review and meta-analysis |
| title_sort | association of race and ethnicity with mortality in adults with sle a systematic literature review and meta analysis |
| url | https://lupus.bmj.com/content/12/1/e001383.full |
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