TOPLINE:

From 2018 to 2023, more than 40% of the deaths among persons aged 15 years or older with systemic lupus erythematosus (SLE) listed on death certificates had SLE recorded as the underlying cause of death; mortality peaked in 2020 and 2021, likely due to the pandemic’s impact. Cardiovascular disease, cancer, and COVID were leading causes of death when SLE was a contributing factor but not the primary cause.

METHODOLOGY:

• Researchers analyzed mortality using death certificate data from 2018 to 2023 for individuals aged 15 years or older with any mention of SLE, using the CDC Wide-ranging Online Data for Epidemiologic Research system.
• SLE mortality was assessed by year, focusing on the impact of the COVID pandemic, and analyzed by age, sex, race/ethnicity, and region.
• The study evaluated the underlying and contributing causes of death, with the underlying cause defined as the main disease or injury leading to death and contributing causes as other factors that also played a role.
• Researchers used ranked cause-of-death lists and diagnostic codes to identify SLE deaths, and age-adjusted death rates per 1,000,000 standardized to the projected 2000 US population were calculated.
• A sensitivity analysis excluded individuals with both SLE and scleroderma to reduce misclassification.

TAKEAWAY:

• A total of 14,936 deaths were identified, of which SLE was the underlying cause in 6414 (42.9%) deaths and a contributing cause in 8522.
• The age-adjusted mortality rate for SLE as the underlying cause remained stable from 2018 to 2021 but increased significantly for SLE as a contributing cause during the same period: from 3.53 (95% CI, 3.31-3.75) in 2018 to 5.07 (95% CI, 4.81-5.33) in 2020 and 5.64 (95% CI, 5.37-5.91) in 2021, likely due to the COVID pandemic. After exclusion of individuals with both SLE and scleroderma, overall age-adjusted SLE mortality peaked in 2020 and 2021.
• Age-adjusted SLE mortality increased with age; it was highest among non-Hispanic African Americans and higher among female vs male individuals, Hispanic vs non-Hispanic individuals, and in the South vs other regions.
• Of the 15 leading underlying causes of death, heart disease (age-adjusted rate, 0.93; 95% CI, 0.89-0.98), cancer (age-adjusted rate, 0.56; 95% CI, 0.52-0.59), and COVID (age-adjusted rate, 0.51; 95% CI, 0.47-0.54) were the most common causes, with SLE as a contributing cause.

IN PRACTICE:

“Management and treatment of SLE as well as preventive measures that address comorbid conditions among people with SLE may lower the risk of mortality for people with SLE,” the authors wrote.

SOURCE:

The study was led by Danielle Dawson, MPH, who was at the Centers for Disease Control and Prevention in Atlanta at the time of the study. It was published online on January 12, 2026, as a brief report in Arthritis Care & Research.

LIMITATIONS:

Mortality could not be estimated for groups with fewer than 20 recorded deaths. Racial and ethnic data were based on death certificates, which may not accurately reflect individuals’ identities. The analysis may underestimate SLE mortality due to the underdiagnosis or misdiagnosis of SLE cases.

DISCLOSURES:

No external funding was provided for this study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.