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Sex Differences in Healthcare Utilization, End-stage Renal Disease and Mortality among Medicaid Beneficiaries with Incident Lupus Nephritis
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3-2018
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Source: Arthritis Rheumatol. 70(3):417-426
[PDF-105.26 KB]
Details:
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Alternative Title:Arthritis Rheumatol
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Personal Author:
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Description:Objective
While systemic lupus erythematosus (SLE) and lupus nephritis (LN) disproportionately affect females, prior studies suggest that males may experience poorer outcomes. We investigated sex differences in healthcare utilization, end-stage renal disease (ESRD) and mortality among patients with LN receiving Medicaid, public insurance for low-income individuals.
Methods
Within Medicaid Analytic eXtract (MAX) from 29 states (2000–2010), we used billing claims to identify individuals 5–65 years with incident LN (PPV 80%). MAX data were linked to the US Renal Data System to determine ESRD, and to Social Security Death Index files to determine death. We estimated adjusted incidence rate ratios (IRR) by sex for healthcare utilization using Poisson regression and used multivariable proportional hazards models to compare risks of ESRD and death by sex.
Results
Of 2750 patients with incident LN, 283 (10%) were male. Mean follow-up was 3.1 (SD 2.3). Mean age was 25 (SD 14) years among males; 30 (SD 14) among females (p<0.01). Males had fewer outpatient (IRR 0.88, 95% CI 0.80–0.97) and emergency department visits (IRR 0.75, 95% CI 0.63–0.90). The 5-year cumulative incidence of ESRD was 22.3% in males, 21.2% in females and of death, 9.4% in males, 9.8% in females. There were no sex differences in ESRD (HR 1.02, 95% CI 0.73–1.41, ref=females) or death (HR 0.81, 0.47–1.35).
Conclusion
In this incident LN cohort, ESRD and mortality were extremely high overall, but not increased among males compared to females. In this vulnerable population, biologic and healthcare utilization differences by sex may not significantly affect outcomes.
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Pubmed ID:29193893
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Pubmed Central ID:PMC5826885
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