Mortality from systemic erythematosus lupus in Brazil: evaluation of causes according to the government health database☆

Costi, Luisa Ribeiro; Iwamoto, Hatsumi Miyashiro; Neves, Dilma Costa de Oliveira; Caldas, Cezar Augusto Muniz

doi:10.1016/j.rbre.2017.09.001

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Original articles • Rev. Bras. Reumatol. 57 (6) • Nov-Dec 2017 • https://doi.org/10.1016/j.rbre.2017.09.001 copy

Mortality from systemic erythematosus lupus in Brazil: evaluation of causes according to the government health database^☆ ☆ Work developed at the Centro Universitário do Estado do Pará (CESUPA), Serviço de Reumatologia, Belém, PA, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To characterize the causes of mortality in patients with systemic lupus erythematosus (SLE) in Brazil between 2002 and 2011.

Methods:

An exploratory ecological study of a time series using data from the Mortality Information System of DATASUS, the Department of the Unified Health System (Brazil's National Health System).

Results:

Brazil's SLE mortality rate was 4.76 deaths/10⁵ inhabitants. The mortality rate was higher in the Midwest, North and Southeast regions than in the country as a whole. There were 6.3% fewer and 4.2% more deaths than expected in the Northeast and Southeast regions, respectively. The mean age at death was 40.7 ± 18 years, and 45.61% of deaths occurred between the ages of 20 and 39. Incidence was highest in women (90.7%) and whites (49.2%). Disorders of the musculoskeletal system and connective tissue were mentioned as an underlying cause of death in 77.5% of cases, and diseases of the circulatory system and infectious and parasitic diseases were also noted in fewer cases. SLE was mentioned as an underlying cause of death in 77% of cases, with no difference between the Brazilian regions (p = 0.2058). The main SLE-related causes of death were, sequentially, diseases of the respiratory and circulatory systems and infectious and parasitic diseases.

Conclusions:

This study identified a need for greater control of risk factors for cardiovascular diseases and a better understanding of the pathogenesis of atherosclerosis in SLE. Infectious causes are still frequent, and management should be improved, especially in the early stages of the disease.

Keywords:
Systemic erythematosus lupus; Mortality; Brazil

Region	Deaths/100,000 inhabitants	Observed deaths (n)	Observed (%)	Expected (%)	Dif. (%)
Brazil	4.76	8761	100.0	100.0	0.0
North	5.40	789	9.0	7.9	1.1
Northeast	3.69	1902	21.7	28.0	-6.3^a a p-Value < 0.0001, Chi-square test.
Southeast	5.23	4076	46.5	42.3	4.2^a a p-Value < 0.0001, Chi-square test.
South	4.28	1143	13.0	14.5	-1.5
Midwest	6.44	851	9.7	7.2	2.5

Variables	n = 8761	%
Gender
Male	812	9.3
Female	7949	90.7^a a p-Value < 0.0001, Chi-square test of goodness of fit.

Race
White	4310	49.2^a a p-Value < 0.0001, Chi-square test of goodness of fit.
Mixed race	2917	33.3
Black	815	9.3
Yellow	44	0.5
Indigenous	9	0.1
Not reported	666	7.6

Age
15-19	789	9.01
20-39	3996	45.61^a a p-Value < 0.0001, Chi-square test of goodness of fit.
40-59	2888	32.96
60-79	955	10.90
80 and over	133	1.52

ICD Group	MW		NE		N		SE		S		Total
	n	%	n	%	n	%	n	%	n	%	n	%
Musculoskeletal system and connective tissue	677	79.6	1471	77.3	629	79.7	3056	75.0	961	84.1	6794	77.5^a a ICD Groups (p-value < 0.0001), Chi-square test.
SLE	670	98.9	1467	99.7	625	99.4	3030	99.1	953	99.2	6745	99.3^b b Comparison between the regions: p-value < 0.2028, Chi-square test.
Other disorders of the musculoskeletal system and connective tissue	7	1.1	4	0.3	4	0.6	26	0.9	8	0.8	49	0.7
Circulatory system	58	6.8	99	5.2	31	3.9	281	6.9	60	5.2	529	6.0
Infectious and parasitic diseases	23	2.7	96	5.1	35	4.4	158	3.9	19	1.7	331	2.8
Respiratory system	13	1.5	38	2.0	11	1.4	112	2.7	21	1.8	195	2.2
Digestive system	16	1.9	40	2.1	16	2.0	99	2.4	17	1.5	188	2.1
Genitourinary system	17	2.0	38	2.0	19	2.4	83	2.0	6	0.5	163	1.9
Immune disorders	11	1.3	36	1.9	7	0.9	79	1.9	13	1.1	146	1.7
Endocrine, nutritional and metabolic diseases	7	0.8	34	1.8	18	2.3	62	1.5	7	0.6	128	1.5
Neoplasms	9	1.1	14	0.7	7	0.9	73	1.8	20	1.7	123	1.4
Nervous system	6	0.7	12	0.6	6	0.8	30	0.7	9	0.8	63	0.7
Musculoskeletal and connective tissue	7	0.8	4	0.2	4	0.5	26	0.6	8	0.7	49	0.6
Skin and subcutaneous tissue	4	0.5	5	0.3	7	0.9	21	0.5	3	0.3	40	0.5
Pregnancy, childbirth, and the puerperium	7	0.8	14	0.7	3	0.4	13	0.3	6	0.5	43	0.5
Congenital malformations	1	0.1	2	0.1	0	0	2	0	0	0	5	0.1
Other groups	1	0.1	1	0.1	0	0	5	0.1	0	0	5	0.1
Mental disorders	1	0.1	0	0	0	0	2	0	1	0.1	4	0
Eye, ear and mastoid process	0	0	2	0.1	0	0	0	0	0	0	2	0
Total	851	100	1902	100	789	100	4076	100	1143	100	8761	100

Sequential cause	No. of records	%	No. of records/6745
Respiratory system	5081	26.4	75.3^a a p-Value < 0.0001, Chi-square test of goodness of fit.
Circulatory system	3989	20.7	59.1
Infectious and parasitic diseases	3823	19.9	56.7
Genitourinary system	2821	14.7	41.8
Immune disorders	823	4.3	12.2
Digestive system	809	4.2	12.0
Endocrine and metabolic diseases	735	3.8	10.9
Nervous system	380	2.0	5.6
Musculoskeletal system and connective tissue	233	1.2	3.5
Skin and subcutaneous tissue	226	1.2	3.4
Neoplasms	187	1.0	2.8
Mental disorders	65	0.3	1.0
Pregnancy, childbirth, and the puerperium	64	0.3	0.9
Congenital malformations	10	0.1	0.1
Eye, ear and mastoid process	7	0.0	0.1
Total	19,253	100

ICD Group	MW	NE	N	SE	S	Total	p-Value^a a Comparison between the regions: Chi-square test.
Respiratory system	553	1313	608	1665^a a Comparison between the regions: Chi-square test.	942	5081	0.0017
%	10.9	25.8	12.0	32.8	18.5	100.0
Circulatory system	574	515	594	1385^a a Comparison between the regions: Chi-square test.	921	3989	0.0022
%	14.4	12.9	14.9	34.7	23.1	100.0
Infectious and parasitic diseases	653	1123^a a Comparison between the regions: Chi-square test.	622	988	437	3823	0.0277
%	17.1	29.4	16.3	25.8	11.4	100.0
Genitourinary system	567	598	638^a a Comparison between the regions: Chi-square test.	528	491	2821	0.9340
%	20.1	21.2	22.6	18.7	17.4	100.0

Sequential cause of death	Age of patient with SLE
	Under 19	20-39^a a p < 0.0001, Chi-square test of independence.	40-59	60-79	80 and over	Total
Respiratory system	454	2072	1567	779	209	5081
%	8.9	40.8	30.8	15.3	4.1	100.0
Circulatory system	197	1452	1256	712	372	3989
%	4.9	36.4	31.5	17.8	9.3	100.0
Infectious and parasitic diseases	581	1247	986	766	243	3823
%	15.2	32.6	25.8	20.0	6.4	100.0
Genitourinary system	328	1232	761	337	163	2821
%	11.6	43.7	27.0	11.9	5.8	100.0

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[1] *Corresponding author. E-mail: cezar_caldas@yahoo.com.br (C.A. Caldas).

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Mortality from systemic erythematosus lupus in Brazil: evaluation of causes according to the government health database☆ ☆ Work developed at the Centro Universitário do Estado do Pará (CESUPA), Serviço de Reumatologia, Belém, PA, Brazil.

Abstract

Objective:

Methods:

Results:

Conclusions:

Mortality from systemic erythematosus lupus in Brazil: evaluation of causes according to the government health database^☆ ☆ Work developed at the Centro Universitário do Estado do Pará (CESUPA), Serviço de Reumatologia, Belém, PA, Brazil.