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Ethnic Variation in Disease Patterns and Health Outcomes in Systemic Lupus Erythematosus
SINDHU R. JOHNSON, MURRAY B. UROWITZ, DOMINIQUE IBAÑEZ, and DAFNA D. GLADMAN ABSTRACT. Objective. In a single-center multiethnic lupus cohort, to investigate the influence of ethnicity on the prevalence of cumulative renal and central nervous system (CNS) lupus disease and damage, overall end-organ damage, and mortality. Methods. Clinical features, end-organ damage, and mortality were compared by ethnic origin among patients at a lupus clinic followed prospectively in a longitudinal design over a 32-year period. Statistical analysis to compare demographic features, cumulative disease manifestations, and damage included chi-square test as well as linear, logistic, and Poisson regressions adjusting for disease duration, age at diagnosis, and presence of dialysis and hypertension. Kaplan-Meier and proportional hazard analyses were performed to compare survival. Results. There were a total of 1017 patients: 853 Caucasian, 88 African-Canadian, and 76 Chinese-Canadian. Age at diagnosis was younger and disease duration was shorter for Chinese-Canadians compared to Caucasians, but similar between African-Canadians and Caucasians. There was no significant difference in CNS disease, comparing Caucasians to Chinese-Canadians. However, CNS disease was greater in African-Canadians than Chinese-Canadians. There was no significant difference between ethnic groups in CNS damage. Renal disease was more common in African-Canadians than Caucasians, with no significant difference between Caucasian and Chinese-Canadian patients. Renal damage was more common in African-Canadians and Chinese-Canadians than Caucasians. There was no significant difference in mortality among the 3 ethnic groups. Conclusion. In this single referral center cohort study, there was no significant difference in CNS damage or mortality among the 3 ethnic groups. African-Canadians had a higher prevalence of renal disease and damage. Further investigation into other determinants such as genetic predisposition, treatment, and cultural perceptions is needed. (First Release Aug 15 2006; J Rheumatol 2006;33:1990-5) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS From the Division of Rheumatology, Centre for Prognostic Studies in the Rheumatic Diseases, University of Toronto, Toronto, Ontario, Canada. Dr. Johnson is the recipient of a research fellowship award from The Arthritis Society and the Institute for Musculoskeletal Health and Arthritis, Canadian Institutes of Health Research. S.R. Johnson, MD, FRCPC; M.B. Urowitz, MD, FRCPC; D. Ibanez, MSc; D.D. Gladman, MD, FRCPC, Centre for Prognostic Studies in the Rheumatic Diseases. Address reprint requests to Dr. D.D. Gladman, Division of Rheumatology, Toronto Western Hospital, Edith Cavell Wing 1E-410B 399 Bathurst Street, Toronto, Ontario M5T 2S8. E-mail: Dafna.Gladman@utoronto.ca Accepted for publication May 15, 2006.
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