Age‐Specific Incidence of Systemic Lupus Erythematosus in the United States: A Meta‐Analysis of Data From the Centers for Disease Control and Prevention Lupus Registries

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OBJECTIVE: Epidemiologic estimates for age at systemic lupus erythematosus (SLE) diagnosis are limited, particularly for men and racial and ethnic subpopulations in the United States. Leveraging the Centers for Disease Control and Prevention (CDC) National Lupus Registry network of population-based SLE registries, meta-analyses were performed estimating age-specific incidence of SLE by sex, race, and ethnicity. METHODS: The CDC network of SLE registries includes five state-based registries, plus a sixth Indian Health Service registry. Incidence periods spanned calendar years 2002 to 2018. Registries provided age-specific incidence of SLE, fulfilling the American College of Rheumatology SLE classification criteria, per 100,000 person-years, stratified by sex, race, and ethnicity for the meta-analyses. RESULTS: Incidence rates among women were highest for those aged 30 to 39 years (12.7, 95% confidence interval [CI] 9.5-16.8), whereas rates among men were highest for those aged 60 to 69 years (2.1, 95% CI 1.3-3.4). Black women aged 20 to 39 years had the highest SLE incidence rates (23.6, 95% CI 20.7-26.8). Among women diagnosed with SLE before age 20 years, incidence was highest among Asian individuals (6.5, 95% CI 2.8-15.2). Among women diagnosed with SLE after age 60 years, incidence was highest among American Indian/Alaska Native individuals (9.4, 95% CI 3.4-15.4). Weighted percentages show 10.0% of those with SLE were diagnosed before age 20 years, whereas 15.1% were diagnosed after age 60 years. The largest proportion of individuals with SLE (22.1%) was diagnosed between ages 30 and 39 years. CONCLUSION: This study provides comprehensive sex- and race-specific estimates of age at SLE diagnosis. The substantial later-in-life SLE incidence among men and disease burden in pediatric and older populations should raise awareness in considering SLE in the differential diagnosis in previously underrecognized groups.

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