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

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.