(P-456) Systemic Lupus Erythematosus in a Large, Longitudinal Electronic Health Record Database: Demographics, and Comorbidities - A Focus on African Americans

Background: Systemic Lupus Erythematosus (SLE) is a heterogenous autoimmune disease with a broad range of clinical manifestations with higher incidence and prevalence among non-White individuals (Izmirly, 2021). African Americans (AA) and individuals of African descent are at the highest risk for developing SLE (Lewis and Jawad 2016). Electronic health record (EHR) databases are an efficient source of rich demographic and clinical data on large numbers of SLE patients from diverse settings. To date, limited SLE epidemiologic studies that include significant numbers of AA patients have been conducted in large EHR databases.

Objectives: The main objectives were to describe the demographic characteristics of SLE patients in a large EHR population in the United States (US). In addition, the prevalence of comorbidities among SLE patients were compared to non-SLE matched controls and variations among African American SLE patients were further explored.

Methods: A descriptive longitudinal study was conducted using the Optum® EHR dataset (n=103 million) from 2007 to 2019, across the US including inpatient and ambulatory electronic health records. SLE patients were defined using a validated algorithm specifically developed for EHRs (Barnado, 2017). For each SLE patient, two general population controls free of 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 52,553 adult SLE patients were identified, 91% were female (F/M ratio = 10/1). SLE patients were 64.4% White, 23.7% AA , 2.4% Asian, and 8% Hispanic. Among 12,434 AA SLE patients, 92.7% were female (F/M ratio = 13/1). The mean age at SLE diagnosis (index date) was 48 (±15) years. AA SLE patients average age at diagnosis was ~4 years younger, and a higher proportion of the AA SLE patients (53.5%) compared to the overall SLE populations (45%) were in the 18-45-year age category.
Among comorbidities , diseases of the heart and hypertension occurred 7% and 11% more frequently among AA SLE patients respectively compared to the overall study SLE patients, while the occurrence of joint disorders (78.2% vs 78.8%) and connective tissue disease (76.5% vs 76.3%) were very similar in both groups (Table 1).

Conclusions: These results provide valuable insights into better understanding the demographics and clinical comorbidities among SLE patients especially in AA patients. A strength of this study is the use of a validated algorithm to define SLE patients.