Mortality in Systemic Lupus Erythematous in Milton Cato Memorial Hospital Saint Vincent and the Grenadines; A 5-year Retrospective Study

Main Article Content

Adedeji Okikiade
Ikeokwu Anderson
Twanna Browne-Caesar
Olayinka Afolayan-Oloye
Ugwu David

Abstract

Background: Systemic Lupus Erythematous (SLE) is a rare, severe and lasting autoimmune disease that can vary in severity from mild to possibly life-threatening with a multi-system manifestation characterized by symptoms relating to joint, skin or mucosal inflammation, or with a varying degree of haematological abnormality or constitutional features, with women affected predominantly with peak onset (15-44) years of age.

Aim: This study was aimed at estimating the incidence and mortality of Systemic Lupus Erythematous lupus in Milton Cato Memorial Hospital Saint Vincent and the Grenadines, including temporal trends and variations in age and sex from 2014 to 2018 by using routinely collected administrative health data/patient records.

Methods: From 2014 to 2018, individuals with SLE were identified from the hospital records of Milton Cato Memorial Hospital, which records information on all patient coming in for healthcare services. A structured data extraction tool was employed to extract the data from the hospital record using the open data kit (ODK). Data was analysed using Statistical Package for Social Sciences (SPSS) version 23 and R Studio statistical software for analysis. The Chi-square test was used to test for association. All statistical tests were two-tailed and Level of Confidence was set at 95%, and P=<0.05 was considered to be statistically significant.

Results: The mean age of patient with SLE was 28.52 ± 13.03 years old and the median age was 30 years old, almost all 25(92.6%) were females. Every year, women showed a significantly increase in incidence of Systemic Lupus Erythematous (SLE), there was an annual decrease in the incidence from 2014 to 2018, with a peak incidence in 2016 (0.11/1000 person-years). The lowest incidence was noted in 2018 (0.02/1000 person-years). Among sex, there was an annual decrease in the incidence from 2014 to 2018, with a peak incidence in 2015 and 2016 for male (0.02/1000 person-years) and in 2016 for females (0.21/1000 person-years) respectively. The lowest incidence was noted in 2018 (0.00/1000 person-years) and (0.04/1000 person-years) for both male and female respectively. Case fatality from SLE shows that 2017 had the highest case fatality of 33% compared to the other years, 2014 (25%), 2015(25%) and 2016 (9%) with 2018 having no case fatality at all.

Conclusions: This study showed that the incidence of SLE in Saint Vincent have decreased in the last decade, whereas the mortality rates of SLE have increased. Age and sex were found to be risk factors for SLE. This discovery of increased mortality of SLE suggests that this disease is no longer rare and will have implications for future healthcare planning and health service utilizations.

Keywords:
Systemic Lupus Erythematous (SLE), mortality, incidence, Saint Vincent and the Grenadines

Article Details

How to Cite
Okikiade, A., Anderson, I., Browne-Caesar, T., Afolayan-Oloye, O., & David, U. (2021). Mortality in Systemic Lupus Erythematous in Milton Cato Memorial Hospital Saint Vincent and the Grenadines; A 5-year Retrospective Study. Asian Journal of Medicine and Health, 19(2), 54-72. https://doi.org/10.9734/ajmah/2021/v19i230305
Section
Original Research Article

References

Von Feldt JM. Systemic lupus erythematosus. Recognizing its various presentations. Postgraduate Medicine. 1995;97(4):79,83,86
[Cited 2021 Feb 18]; passim.
Available:https://pubmed.ncbi.nlm.nih.gov/7716094/

Gaubitz M. Epidemiology of connective tissue disorders. Rheumatology. 2006; 45(suppl_3):iii3–4.
[Cited 2020 Feb 25]
Available:https://academic.oup.com/rheumatology/article/45/suppl_3/iii3/2255626

Bernatsky S, Smargiassi A, Barnabe C, Svenson LW, Brand A, Martin RV, et al. Fine particulate air pollution and systemic autoimmune rheumatic disease in two Canadian provinces. Environmental Research. 2016;146:85–91.
[Cited 2021 Feb 18]
Available:https://pubmed.ncbi.nlm.nih.gov/26724462/

Parks CG, De Souza Espindola Santos A, Barbhaiya M, Costenbader KH. Understanding the role of environmental factors in the development of systemic lupus erythematosus. Best Practice & Research Clinical Rheumatology. 2017;31 (3):306–20.
[Cited 2021 Feb 18].
Available:https://pubmed.ncbi.nlm.nih.gov/29224673/

Firestein GS, Budd R, Gabriel SE, O’dell JR, Mcinnes IB. Kelley’s Textbook of Rheumatology: Expert Consult Premium Edition: Enhanced Online Features. London: Elsevier Health Sciences; 2012.

Mok CC. Pathogenesis of systemic lupus erythematosus. Journal of Clinical Pathology. 2003;56(7):481–90.

Schur PH. Review: Genetics of systemic lupus erythematosus. Lupus. 1995;4(6):425–37.

Apostolopoulos D, Hoi AYB. Systemic lupus erythematosus: When to consider and management options. Aust Fam Physician. 2013;42(10):696–700.

Chai HC, Phipps ME, Chua KH. Genetic risk factors of systemic lupus erythematosus in the malaysian population: A minireview. Clin Dev Immunol. 2012;2012.

Fatoye F, Gebrye T, Svenson LW. Real-world incidence and prevalence of systemic lupus erythematosus in Alberta, Canada. Rheumatol Int. 2018;38(9):1721–6.
Available:http://dx.doi.org/10.1007/s00296-018-4091-4.

Flower C, Hennis AJM, Hambleton IR, Nicholson GD, Liang MH. Systemic lupus erythematosus in an African Caribbean population: Incidence, clinical manifestations, and survival in the Barbados National Lupus Registry. Arthritis Care Res. 2012;64(8):1151–8.

Flower C, Hennis A, Hambleton IR, Nicholson G. Lupus nephritis in an Afro-Caribbean population: Renal indices and clinical outcomes. Lupus. 2006;15:689–94.

Bae SC, Fraser P, Liang MH. The epidemiology of systemic lupus erythematosus in populations of African ancestry: A critical review of the “prevalence gradient hypothesis. Arthritis Rheum. 1998;41:2091–9.

Mohd-Yusuf Y, Phipps M, Chow S, & Yeap S. HLA-A∗11 and novel associations in Malays and Chinese with systemic lupus erythematosus, Immunology Letters. 2011;139;1-2:68–72.

Puah S, Lian L, Chew C, Chua K, & Tan S. A study of association of the complement C4 mutations with systemic lupus erythematosus in the Malaysian population, Lupus. 2007;16;9:750– 754,.

Rodriguez M, Williamson T, Vogus A, Macgregor-Skinner E, Pena D-L, Wilson A, et al. Saint Vincent and the Grenadines Health System and Private Sector Assessment. 2012;67–79.

Statistical Office, Government of Saint Vincent and the Grenadines; 2019.
[Cited 2021 Feb 17].
Available: http://stats.gov.vc.

World Bank. World Development Indicators. Washington, DC: IBRD/World Bank;2011.
Accessed September 15, 2011.
Available: http://data.worldbank.org/.

Ministry of Health, Wellness and the Environment (MOHE). Strategic Plan for Health. Kingstown, St. Vincent; 2007–2012.

Gillespie J. Short-term technical assistance for feasibility study and drafting of financial proposal for the health sector improvement and reform programme in St. Vincent and the Grenadines. ECORYS Health Consortium. Rotterdam, Netherlands; 2010.

Nakagawa S, Cuthill IC. Effect size, confidence interval and statistical significance: A practical guide for biologists. Biological Reviews. 2007;8(4): 591–605.

Bae EH, Lim SY, Han K Do, Jung JH, Choi HS, Kim HY, et al. Trend of prevalence and incidence of systemic lupus erythematosus in South Korea, 2005-2015: A nationwide population-based study. Korean J Intern Med. 2020;35(3):652–61.

Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W. The worldwide incidence and prevalence of systemic lupus erythem atosus: A systematic review of epide miological studies. Rheumatology. 2017;56 (11):1945–61.
Available:https://academic.oup.com/rheumatology/article/56/11/1945/4079913

Lerang K, Gilboe I-M, Steinar Thelle D, Gran JT. Mortality and years of potential life loss in systemic lupus erythematosus: a population-based cohort study. Lupus. 2014;23(14):1546–52.

[Cited 2021 Feb 18];23(14):1546–52.

Nightingale AL, Farmer RDT, de Vries CS. Systemic lupus erythematosus prevalence in the U.K.: methodological issues when using the General Practice Research Database to estimate frequency of chronic relapsing-remitting disease. Pharmacoe- pidemiology and Drug Safety. 2007;16(2):144–51.

Izmirly PM, Wan I, Sahl S, Buyon JP, Belmont HM, Salmon JE, et al. The Incidence and Prevalence of Systemic Lupus Erythematosus in New York County (Manhattan), New York: The Manhattan Lupus Surveillance Program. Arthritis & Rheumatology. 2017;69(10):2006–17.

Barbhaiya M, Feldman CH, Guan H, Gómez-Puerta JA, Fischer MA, Solomon DH, et al. Race/Ethnicity and Cardiova- scular Events Among Patients with Systemic Lupus Erythematosus. Arthritis & Rheumatology. 2017;69(9):1823–31.

Ingvarsson R, Bengtsson A, Jönsen A. Variations in the epidemiology of systemic lupus erythematosus in southern Sweden. Lupus. 2016;25(7):772–80.

Hermansen ML, Lindhardsen J, Torp-Pedersen C, Faurschou M, Jacobsen S. The risk of cardiovascular morbidity and cardiovascular mortality in systemic lupus erythematosus and lupus nephritis: A Danish nationwide population-based cohort study. Rheumatology (Oxford, England). 2017;56(5):709–15.
[Cited 2021 Feb 18].
Available:https://pubmed.ncbi.nlm.nih.gov/28053276/

Gómez-Puerta J, Barbhaiya M, Guan H, Feldman C, Alarcón G, et al. Racial/Ethnic variation in all-cause mortality among United States medicaid recipients with systemic lupus erythematosus: A Hispanic and asian paradox. Arthritis & Rheumatology (Hoboken, NJ). 2015;67(3):752–60.
[Cited 2021 Feb 18].
Available:https://pubmed.ncbi.nlm.nih.gov/25590668/

Rees F, Doherty M, Grainge M, Lanyon P, Davenport G, Zhang W. Mortality in systemic lupus erythematosus in the United Kingdom 1999–2012. Rheumato- logy. 2016;55(5):854– 60.