Prevalence and demographics of systemic lupus erythematosus and lupus nephritis among US children with Medicaid coverage, 2002-2004

Purpose

Little is known about the prevalence or sociodemographics of systemic lupus erythematosus (SLE) among children on Medicaid, the government-funded program which pays for medical care for those who cannot afford it. We investigated nationwide prevalence and sociodemographic characteristics of SLE among children on Medicaid.

Methods

Children aged 5-19 years with SLE (> 2 ICD-9 codes of 710.0) were identified from Medicaid Analytic eXtract (MAX) data, containing all inpatient and outpatient claims codes for Medicaid patients for all 50 U.S. States, 2002-2004. Within this group, lupus nephritis was identified from billing codes for > 2 of a range of ICD-9 codes for glomerulonephritis, proteinuria and renal failure (PPV 88%, validated by Chibnik et al., 2009). We calculated the prevalence of SLE and lupus nephritis among Medicaid-eligible children and within specific sociodemographic segments.

Results

Of 25,531,034 children covered by Medicaid from 2002 to 2004, 4515 with SLE were identified: SLE prevalence was 17.7 per 100,000. Of those, 85% were female, 38% Black, 23% Hispanic and 25% White; 43% resided in the South and 23% in the West. Overall, 1655 (37%) of children with SLE had lupus nephritis (prevalence: 6.5 per 100,000). Table 1 shows the prevalence of SLE and lupus nephritis per 100,000 among specific demographic groups of children with Medicaid. Lupus nephritis was more common among Native American (45%), Black (41%), Asian (42%) and Hispanic (35%) children with SLE than among white children (27%).

Table 1 Prevalence of SLE and lupus nephritis among US children aged 5-19 years, 2002-2004, (per 100,000 Medicaid-eligible children)

Conclusion

The prevalence of SLE among children with Medicaid medical insurance in the U.S., 2002-2004, was 17.7 per 100,000. The majority was non-white and over a third had been evidence of lupus nephritis. Future studies are required to explore predictors of outcomes of SLE in this population.

Disclosure

Linda T. Hiraki: None; Tamara Shaykevich: None; Wolfgang C. Winkelmayer: None; Karen H. Costenbader: None.