Assessing Morbidity and Mortality in Systemic Lupus Erythematosus Patients Treated at the University of Mississippi Medical Center

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that has been increasing in prevalence in the U.S. for decades, with an estimated 1.5 million patients in 2024, representing a significant health and economic burden. Approximately 9 in 10 SLE patients are female, and they are usually between the ages of 15-44 at diagnosis. The incidences of cardiovascular disease, kidney disease, and hypertension in SLE patients are much higher than the age matched general population, but the impact of race, treatments, and socioeconomic factors such as insurance is unclear. Because of the complex interplay between SLE, cardiovascular disease, and kidney disease, we sought to investigate the most significant contributors to morbidity and mortality rates in SLE patients treated at the University of Mississippi Medical Center (UMMC) using real world data. Data were collected from the UMMC Research Data Warehouse (RDW), a clinical databank of electronic health records containing approximately 1.8 million patients and over 50 million encounters. Data from the RDW are de-identified and exempt from IRB approval. Data from 2013 to 2023 were retrieved from patients ≥16 years old with a clinical SLE diagnosis, yielding 3,421 patients. The probability of all-cause mortality in SLE patients over 40 years old with CKD was significantly higher than those without, reaching nearly 30% at 10 years compared to approximately 13% in those without CKD (p<0.0001). Additionally, all-cause mortality in SLE patients using Medicaid exceeded 20% at 10 years compared to approximately 14% in patients who did not use Medicaid (p=0.02). Using Cox proportional hazard regression models, heart failure (HF), chronic kidney disease (CKD), usage of Medicaid, and age were shown to be independently associated with an increased risk of all-cause mortality in SLE patients. In patients prescribed methotrexate, there was a decreased risk of lupus nephritis, a major driver of CKD, while there was a significantly increased risk of lupus nephritis in black patients or patients on Medicaid. Indeed, the cumulative hazard for developing CKD over a mean follow-up of 4.5 years was 2.5 in patients on Medicaid compared to 0.5 in those without. Our analysis of real-world data highlights the significant impact of comorbidities such as CKD, HF, and socioeconomic factors on morbidity and mortality rates in SLE patients and warrants more controlled studies on renoprotective treatments in this vulnerable patient population. U54GM115428, U54HL169191, R00MD014738, R00HL146888 This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.