Anantharaj Aruna, Yelagapuri Dr Rohit Rao, Singh Parth Vikram, Nadeem Aayza, Deoghare Shreya
Internal Medicine, Wuhan University School of Medicine, Hubei, CHN.
Intensive Care Unit, Ramdev Rao Hospital, Hyderabad, IND.
Cureus. 2025 Aug 4;17(8):e89313. doi: 10.7759/cureus.89313. eCollection 2025 Aug.
Systemic lupus erythematosus (SLE) is an autoimmune disease, more prevalent among African-American women, often associated with severe manifestations such as lupus nephritis and neuropsychiatric lupus. Both conditions contribute significantly to morbidity and mortality, though lupus nephritis is more commonly linked to direct disease-related deaths. Mortality can also result from other severe disease manifestations or treatment-related complications. Assessing disparities in place of death among lupus patients is essential for improving care quality through targeted physician and patient education.
The aim of this study is to evaluate disparities in the place of death (hospital, nursing home, hospice, and home) among lupus patients in the United States of America (USA), based on demographic characteristics like age, gender, race, and geographic regions.
A retrospective study was conducted in September 2023 using Centers for Disease Control and Prevention - Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data, focused on deaths attributed to lupus erythematosus (International Classification of Diseases, Tenth Revision (ICD-10) Code: L93, including L93.0, L93.1, and L93.2). It analyzed disparities in death location (home/hospice, medical facility/nursing home, others that include unknown locations or unspecified categories where the place of death could not be conclusively determined) across four variables employing statistical tools STATA15 (StataCorp LLC, College Station, TX) and R3.6.3 (The R Core Team, R Foundation for Statistical Computing, Vienna, Austria).
A total of 3,937 deaths from 1999 to 2020 were included in the analysis from the CDC WONDER database, which showed 1,269 deaths were in home/hospice, 2,517 in medical/nursing facilities, and 151 at other unknown/unspecified locations. Higher odds of home/hospice deaths were noted in ages 55-64 years (1.606) and 65-74 years (1.576), males (1.306 times more than females), patients who were American Indian/Alaska Native (3.447), and those in Census region 3: South (1.459).
Lupus patients above 50 years, males, and those of American Indian/Alaskan race, and from the Census region 3 (South) have an increased likelihood of dying in home/hospice care. Future predictions till 2025 using the AutoRegressive Integrated Moving Average (ARIMA) model indicate an increasing trend of cumulative home/hospice mortality.
系统性红斑狼疮（SLE）是一种自身免疫性疾病，在非裔美国女性中更为普遍，常伴有严重表现，如狼疮性肾炎和神经精神性狼疮。这两种情况都对发病率和死亡率有显著影响，尽管狼疮性肾炎更常与直接的疾病相关死亡有关。死亡率也可能由其他严重的疾病表现或治疗相关并发症导致。评估狼疮患者死亡地点的差异对于通过有针对性的医生和患者教育来提高护理质量至关重要。
本研究的目的是根据年龄、性别、种族和地理区域等人口统计学特征，评估美国狼疮患者在死亡地点（医院、疗养院、临终关怀机构和家中）的差异。
2023年9月进行了一项回顾性研究，使用疾病控制和预防中心的广泛在线流行病学研究数据（CDC WONDER），重点关注归因于红斑狼疮的死亡（国际疾病分类第十版（ICD - 10）代码：L93，包括L93.0、L93.1和L93.2）。它使用统计工具STATA15（StataCorp有限责任公司，德克萨斯州大学站）和R3.6.（R核心团队，R统计计算基金会，奥地利维也纳）分析了四个变量在死亡地点（家中/临终关怀机构、医疗机构/疗养院、其他包括未知地点或未明确分类且无法最终确定死亡地点的类别）方面的差异。
从CDC WONDER数据库纳入了1999年至2020年的3937例死亡病例进行分析，结果显示1269例在家中/临终关怀机构死亡，2517例在医疗/护理机构死亡，151例在其他未知/未明确地点死亡。在55 - 64岁（1.606）和65 - 74岁（1.576）年龄段、男性（是女性 的1.306倍）、美国印第安/阿拉斯加原住民患者（3.447）以及人口普查区域3：南部（1.459）的患者中，在家中/临终关怀机构死亡的几率更高。
50岁以上的狼疮患者、男性、美国印第安/阿拉斯加种族的患者以及来自人口普查区域3（南部）的患者在家中/临终关怀护理中死亡的可能性增加。使用自回归积分移动平均（ARIMA）模型对2025年之前的未来预测表明，家中/临终关怀机构累积死亡率呈上升趋势。
