2000 - 2004年美国有医疗补助覆盖的成年人中系统性红斑狼疮和狼疮性肾炎的流行病学及社会人口统计学特征
Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000-2004.
作者信息
Feldman Candace H, Hiraki Linda T, Liu Jun, Fischer Michael A, Solomon Daniel H, Alarcón Graciela S, Winkelmayer Wolfgang C, Costenbader Karen H
机构信息
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
出版信息
Arthritis Rheum. 2013 Mar;65(3):753-63. doi: 10.1002/art.37795.
OBJECTIVE
Systemic lupus erythematosus (SLE) and lupus nephritis (LN) disproportionately affect individuals who are members of racial/ethnic minority groups and individuals of lower socioeconomic status (SES). This study was undertaken to investigate the epidemiology and sociodemographics of SLE and LN in the low-income US Medicaid population.
METHODS
We utilized Medicaid Analytic eXtract data, with billing claims from 47 states and Washington, DC, for 23.9 million individuals ages 18-65 years who were enrolled in Medicaid for >3 months in 2000-2004. Individuals with SLE (≥3 visits >30 days apart with an International Classification of Diseases, Ninth Revision [ICD-9] code of 710.0) and with LN (≥2 visits with an ICD-9 code for glomerulonephritis, proteinuria, or renal failure) were identified. We calculated SLE and LN prevalence and incidence, stratified by sociodemographic category, and adjusted for number of American College of Rheumatology (ACR) member rheumatologists in the state and SES using a validated composite of US Census variables.
RESULTS
We identified 34,339 individuals with SLE (prevalence 143.7 per 100,000) and 7,388 (21.5%) with LN (prevalence 30.9 per 100,000). SLE prevalence was 6 times higher among women, nearly double in African American compared to white women, and highest in the US South. LN prevalence was higher among all racial/ethnic minority groups compared to whites. The areas with lowest SES had the highest prevalence; areas with the fewest ACR rheumatologists had the lowest prevalence. SLE incidence was 23.2 per 100,000 person-years and LN incidence was 6.9 per 100,000 person-years, with similar sociodemographic trends.
CONCLUSION
In this nationwide Medicaid population, there was sociodemographic variation in SLE and LN prevalence and incidence. Understanding the increased burden of SLE and its complications in this low-income population has implications for resource allocation and access to subspecialty care.
目的
系统性红斑狼疮（SLE）和狼疮性肾炎（LN）对种族/族裔少数群体成员以及社会经济地位（SES）较低的个体影响尤为严重。本研究旨在调查美国低收入医疗补助人群中SLE和LN的流行病学及社会人口统计学情况。
方法
我们利用了医疗补助分析提取数据，这些数据来自47个州和华盛顿特区的计费索赔记录，涉及2000 - 2004年参加医疗补助超过3个月的18 - 65岁的2390万人。确定患有SLE（间隔超过30天的就诊次数≥3次，国际疾病分类第九版[ICD - 9]编码为710.0）和LN（就诊次数≥2次，ICD - 9编码为肾小球肾炎、蛋白尿或肾衰竭）的个体。我们按社会人口统计学类别分层计算SLE和LN的患病率和发病率，并使用经过验证的美国人口普查变量综合指标，对该州美国风湿病学会（ACR）成员风湿病学家数量和SES进行调整。
结果
我们确定了34339例SLE患者（患病率为每10万人143.7例）和7388例（21.5%）LN患者（患病率为每10万人30.9例）。SLE患病率在女性中高出6倍，非裔美国女性与白人女性相比几乎高出一倍，在美国南部最高。与白人相比，所有种族/族裔少数群体中的LN患病率更高。SES最低的地区患病率最高；ACR风湿病学家最少的地区患病率最低。SLE发病率为每10万人年23.2例，LN发病率为每10万人年6.9例，具有相似的社会人口统计学趋势。
结论
在这个全国性的医疗补助人群中，SLE和LN的患病率及发病率存在社会人口统计学差异。了解低收入人群中SLE及其并发症负担的增加，对于资源分配和获得专科护理具有重要意义。
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