Long-term trends of mortality from systemic lupus erythematosus in England & Wales and the United States

ObjectivesThe occurrence of a birth-cohort pattern underlying the time trends of any given disease is indicative of exposure to environmental risk factors during early life with long-lasting consequences that influence the disease occurrence during patients' subsequent lifetime. The present analysis serves to test whether the time trends of systemic lupus erythematous (SLE) in England & Wales and the United States are characterized by a similar birth-cohort patterns as other autoimmune diseases associated with Epstein-Barr virus (EBV).MethodsIn an observational study using the Vital Statistics of England & Wales and the United States from 1951 to 2022, the mortality trends of SLE were compared to those of Hodgkin lymphoma (HL), multiple sclerosis (MS), Crohn's disease (CD), and ulcerative colitis (UC).ResultsMortality from SLE rose among generations born during the 19^th century and decreased among generations born subsequently during the 20^th century. This birth-cohort pattern of SLE was matched by almost identical patterns underlying the occurrence of MS and CD, whereas mortality from HL and UC were similarly characterized by a birth-cohort patterns with a rise and fall in mortality that were shifted by 10-20 years towards earlier generations when compared to SLE, MS, and CD.ConclusionThe similarities in the birth-cohort patterns of SLE and other EBV-associated diagnoses suggest that they all share a common risk factor, such as EBV infection. The trends of SLE may have been shaped by underlying trends in the acquisition of EBV infection during adolescence or early adulthood.