Systemic lupus erythematosus (SLE) is a serious chronic autoimmune disease with substantial morbidity and mortality. Although improved diagnostics and therapeutics have contributed to declining ...mortality rates, important disparities exist in SLE survival rates by race, ethnicity, gender, age, country, and social disadvantage. This review highlights the burden of SLE and lupus nephritis among Medicaid beneficiaries, outlines barriers in access to high-quality SLE care and medication adherence in the Medicaid SLE population, and summarizes disparities in adverse outcomes among SLE patients enrolled in Medicaid.
Objective
Nearly 25% of patients with systemic lupus erythematosus (SLE) are hospitalized yearly, often for outcomes that may have been avoided if patients had received sustained outpatient care. We ...examined acute care use for vaccine‐preventable illnesses to determine sociodemographic contributors and modifiable predictors.
Methods
Using US Medicaid claims from 29 states (2000–2010), we identified adults (18–65 years) with prevalent SLE and 12 months of enrollment prior to the first SLE code (index date) to identify baseline data. We defined acute care use for vaccine‐preventable illnesses as emergency department (ED) or hospital discharge diagnoses for influenza, pneumococcal disease, meningococcal disease, herpes zoster, high‐grade cervical dysplasia/cervical cancer, and hepatitis B after the index date. We estimated the incidence rate of vaccine‐preventable illnesses and used Cox regression to assess risk (with hazard ratios and 95% confidence intervals) by sociodemographic factors and health care utilization, adjusting for vaccinations, comorbidities, and medications.
Results
Among 45,654 Medicaid beneficiaries with SLE, <10% had billing claims for vaccinations. There were 1,290 patients with ≥1 ED visit or hospitalization for a vaccine‐preventable illness (6.6 per 1,000 person‐years); 93% of events occurred in unvaccinated patients. Patients who were Black compared to White had 22% higher risk. Greater outpatient visits were associated with lower risk.
Conclusion
Medicaid beneficiaries with SLE who are not vaccinated are at risk for potentially avoidable acute care use for vaccine‐preventable illnesses. Racial disparities were noted, with a higher risk among Black patients compared to White patients. Greater outpatient use was associated with reduced risk, suggesting that access to ambulatory care may reduce avoidable acute care use.
Objective
We studied posttraumatic stress disorder (PTSD), a severe trauma‐related mental disorder, and systemic lupus erythematosus (SLE) risk in a large, diverse population enrolled in Medicaid, a ...US government‐sponsored health insurance program for low‐income individuals.
Methods
We identified SLE cases and controls among patients ages 18–65 years enrolled in Medicaid for ≥12 months in the 29 most populated US states from 2007 to 2010. SLE and PTSD case statuses were defined based on validated patterns of International Classification of Diseases, Ninth Revision codes. Index date was the date of the first SLE code. Controls had no SLE codes but had another inpatient or outpatient code on the index date and were matched 1:10 to cases by age, sex, and race. Conditional logistic regressions calculated odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association of PTSD with incident SLE, adjusting for smoking, obesity, oral contraceptive use, and other covariates.
Results
A total of 10,942 incident SLE cases were matched to 109,420 controls. The prevalence of PTSD was higher in SLE cases, at 10.74 cases of PTSD per 1,000 person‐years (95% CI 9.37–12.31) versus 7.83 cases (95% CI 7.42–8.27) in controls. The multivariable‐adjusted OR for SLE among those with PTSD was 2.00 (95% CI 1.64–2.46).
Conclusion
In this large, racially and sociodemographically diverse US population, we found patients with a prior PTSD diagnosis had twice the odds of a subsequent diagnosis of SLE. Studies are necessary to clarify the mechanisms driving the observed association and to inform possible interventions.
Hydroxychloroquine (HCQ), an antimalarial agent, was first approved by the U.S. Food and Drug Administration for the treatment of rheumatic diseases in 1955 and has since become a crucial ...disease-modifying antirheumatic drug (DMARD). It is now a standard-of-care medication for the treatment of systemic lupus erythematosus (SLE) and part of the triple-therapy regimen for rheumatoid arthritis (RA). While risks of cardiotoxicity and specifically conduction abnormalities have been documented, they are thought to be rare.
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