(22) Cutaneous Lupus Erythematosus in a Large, Longitudinal Electronic Health Record Database in the United States: Demographics, and Comorbidities - A Focus on African Americans
Background: Cutaneous Lupus Erythematosus (CLE) is an autoimmune disease that may present with or without systemic manifestations. There are limited published population-based, epidemiologic studies on CLE, most of which have been conducted in the United States (US) and Europe in predominantly White populations. Two published studies from the US suggest a higher incidence and prevalence of CLE among non-White individuals (Drenkard, 2019, Izmirly, 2019). Some evidence suggests that there are ethnoracial differences in the clinical presentation of CLE. Electronic health record (EHR) databases are an efficient source of rich demographic and clinical data on large numbers of CLE patients from diverse settings. To date, limited CLE epidemiologic studies that include significant numbers of African American (AA) patients have been conducted in large EHR databases.
Objectives: The main objectives were to describe the demographic characteristics of CLE patients in a large EHR population in the United States (US). In addition, the prevalence of comorbidities among CLE patients were compared to non-CLE matched controls and variations among African American CLE patients were further explored.
Methods: A descriptive longitudinal study was conducted using the Optum Deidentified Electronic Health Record Dataset (n=103 million) from 2007 to 2019, across the US including inpatient and ambulatory electronic health records. For each CLE patient, two general population controls free of CLE or SLE any time in the database, were matched to the cases on: year of birth, gender, total time in the database, and enrollment status. Comorbidities were classified using the Clinical Classification System developed by the Agency for Health Research Quality (CCSR).
Results: A total of 27,532 adult CLE patients were identified, 81% were female (F/M ratio = 4/1). CLE patients were 70.5% White, 17.9% AA, 1.6% Asian, and 4.8% Hispanic. Among 4,924 AA CLE patients, 82.5% were female (F/M ratio = 5/1). The mean age at CLE diagnosis (index date) was 53.3 (±15) years. Among AA CLE patients average age at diagnosis was ~4 years younger, and a higher proportion of the AA CLE patients (38.7%) compared to the overall SLE populations (31.2%) were in the 18-45-year age category. Among comorbidities, hypertension occurred 9% more frequently among AA CLE patients compared to the overall study CLE patients, while the occurrence of joint disorders (62.1% vs 63.3%) and connective tissue disease (60.9 vs 62.7%) were very similar in both groups.
Conclusions: These results provide valuable insights into better understanding the demographics and clinical comorbidities among CLE patients especially in AA patients.
