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Trends in recent systemic lupus erythematosus mortality rates.

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TRENDS IN RECENT
SYSTEMIC LUPUS ERYTHEMATOSUS
MORTALITY RATES
MARK F. GORDON, PAUL D. STOLLEY, and RITA SCHINNAR
National death rates from systemic lupus erythematosus (SLE) were calculated for the period 1972
to 1976 according to age, sex, and race and were compared to rates for 1968 to mid-1972. The time trend in
the age-adjusted death rates from SLE was also analyzed for the entire period 1968 to 1977. The previously
reported variable sex and race ratios persist through the
recent period, particularly the greater mortality rates
among black women during middle and early adulthood.
An overall decline in the adjusted death rates in the
younger age groups (1-49 years old) in each race-sex
group is seen in the recent period.
Although the pathogenesis of systemic lupus erythematosus (SLE) remains unclear, various epidemiologic features of SLE have been notable, especially its
frequency distribution by “host factors” of age, sex, and
race. SLE is predominantly a disease of young and
middle-aged women with an estimated 9: 1 female to
male ratio in the childbearing years, decreasing to 2: 1
in older age groups (1,2). The several studies which addressed mortality due to SLE show a particularly high
incidence among black females.
Cobb’s review of the United States mortality
rates between 1959 and 1961 showed rates of 1.1 and 4.7
Supported by grants from the Dana Foundation and the
Rockefeller Foundation.
Mark F. Gordon: Benjamin Franklin Scholar, Faculty of
Arts and Sciences, University of Pennsylvania; Paul D. Stolley, MD,
MPH, and Rita Schinnar, MPA: Clinical Epidemiology Unit, Department of Medicine, University of Pennsylvania, Philadelphia.
Address reprint requests to Paul D. Stolley, MD, Clinical
Epidemiology Unit, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104.
Submitted for publication July 28, 1980; accepted in revised
form December 18, 1980.
Arthritis and Rheumatism, Vol. 24, No. 6 (June 1981)
per million person-years for males and females, respectively, of all ages (3). The sex differences were most pronounced in the childbearing ages (i.e., 15-50 years old).
This finding has been cited by some investigators as
suggesting a hormonal role in altering autoimmunity
(43). Since studies have shown that androgens may
suppress an animal model of this disease (i.e., NZBI
NZW murine lupus) while estrogens may accelerate its
activity, it has been postulated that increased estrogenic
stimulation associated with the reproductive period may
account for the higher prevalence of SLE in women of
childbearing age (4,6,7). Cobb also noted that males
reached maximum mortality from SLE at about age 65,
while females experience maximum mortality at about
age 40.
Based on a population study of New York City
residents conducted during 1955 to 1964, Siegel and Lee
calculated that the average annual mortality rates were
1.9 and 8.3 deaths per million population for males and
females, respectively (8).
The significant racial difference which Cobb
noted using national statistics (SLE mortality rates of
4.0 and 10.6 per million person-years for white females
and black females, respectively, in 1959-6 1) persisted
also in Siegel and Lee’s analysis in New York City (SLE
mortality rates of 5.5 and 15.4 per million person-years
for white females and black females, respectively, in
1955-64). An interesting finding by Siegel and Lee concerns SLE mortality in Puerto Ricans living in New
York City, which appeared to be higher than the mortality in whites and lower than that in blacks (8), though
it is based on numbers too small to be interpreted with
confidence.
More recently, Kaslow and Masi calculated the
national mortality rates for the period 1968 to 1972 (2).
SLE MORTALITY RATES
BLACK
:J~
I FEMALES
763
group. An increase in mortality in the older age groups
is shown, but this is statistically significant only for
white females.
A
METHODS
WHITE FEMALES
1968-1972
1972- 1976
vx'
972- I976
02
7
-
'0
5
I0
15 20 25 30 35 40 45 50 55 60 6 5 70 75 80 85
AGE (years)
Figure 1. U.S.mortality rates for systemic lupus erythematosus (per
100,OOO population per year) by 5-year age groups, sex, and race in
1968-1972 and 1972-1976.
The overall rate for females, 6.3 per million personyears (whites 5.2, blacks 14.8), was about four times that
for males, 1.6 per million person-years (whites 1.5,
blacks 2.2). The overall rate for blacks, 8.8, was 2.6-fold
greater than for whites which was 3.4 (2). As did Cobb,
Kaslow and Masi also reported an earlier rise in agespecific mortality rates for females than for males, and a
gradual increase in mortality with age in whites. This
contrasts with the phenomenon of early rise and subsequent decline during the early and middle adult years
in blacks, particularly females.
The studies done to date do not yet provide any
clearly identifiable secular trends in SLE mortality. This
study: 1) includes United States mortality data for 1972
to 1977; 2) corroborates the patterns of death from SLE
reported in previous accounts, i.e., the variability in the
female-to-male sex ratio with age, and the higher relative frequency of deaths in blacks, especially black
women; and 3) documents a recent decline in the mortality rates in the younger age groups in each race-sex
The number of deaths by age, sex, and race were tabulated from unpublished computerized data from 1972 to 1976
supplied by the National Center for Health Statistics (NCHS).
Estimates of the population in each age, sex, and race category were obtained from published United States Bureau of
the Census estimates of the 1974 U S . population (9).
Age-, sex-, and race-specific average annual mortality
rates for SLE were calculated by dividing the average number
of deaths during 1972 to 1976 by the mid-year population in
each category, excluding persons under 1 year of age. Mortality rates for the two periods, 1968-72 (2) and 1972-76, were
then compared (Figure 1 and Appendix A). Additionally, ratios of age-specific sex and race mortality rates for SLE were
computed (Table 1).
Finally, for each race-sex group, the population in
each year since 1968 was grouped into two major age-groups
( 1 4 9 years old and 50-80+ years old) in order to investigate
the time trend in mortality in the aggregated groups of
younger and older populations (Appendix B). For this analysis, the mortality rates were age-adjusted to the age distribution of the U.S. population in 1970. Then, Pearson's rank order correlation coefficient (r,) was used to test the null
hypothesis of no trend in the ranked standardized mortality
rates against the alternative that the higher age-adjusted death
rates are associated with the earlier years and the lower adjusted death rates are associated with the more recent years.
RESULTS
A total of 3,722 deaths in the United States were
attributed to SLE during the 5-year period studied: 550
in white males, 2,115 in white females, 122 in nonwhite
males, and 935 in nonwhite females.*
Extension of the trend analysis of SLE mortality
through 1976 continues to reveal the presence of systematic sex and race variations as reported in earlier investigations. SLE mortality in white males is the lowest
(Table lA), approximately 0.2 deaths per 100,000 population through the young and adult years, reaching its
peak only by age 60 and older. Even in old age, the
death rate from SLE is not high, never exceeding 0.6
deaths per 100,000 population. In the period 1972-76,
the mortality of white males in the younger age groups
appears to be lower than in 1968-72 for comparable age
groups. In contrast, mortality rates increased in the
*Throughout this report, calculations for nonwhite rates are based on
the number of deaths and denominator populations of nonwhites.
However, because the 1968 to 1972 rates are in terms of blacks, we
have assumed the nonwhite rates to be for the black population, since
blacks comprise the largest segment (about 88%) of the nonwhite population in the United States.
GORDON ET AL
164
Whereas the above analysis focused on a comparison between the two consecutive 5-year periods of
SLE mortality, the focus in the subsequent analysis is
on the time trend in the age-adjusted rates of death
from SLE over the entire 10-year period through 1977.
As seen in Appendix B, there was an overall decline in the age-adjusted death rates for the younger age
group (1-49 years old) in each race-sex group. This decline was statistically significant for white males (Table
1B; rs = -0.75, P < 0.02), white females (Table 2B; r, =
-0.87, P < 0.002), and black females (Table 4B; r, =
-0.80, P < O.Ol), but was not statistically significant for
black males (Table 3B; r, = -0.35). For the older age
group (50-85+ years old), there was a significant overall
increase in the adjusted death rates only for white
women (r, = 0.71, P < 0.02). No significant trend
showed in the adjusted death rates of black females (rs
= 0.25), black males (r, = 0.31), or white males (r, =
-0.08) in the older age group.
older age groups in 1972-76, as compared to the previous 5-year period (Figure 1). The same phenomenon
of lowered death rates in the younger age groups in the
more recent 5-year period (1972-76) is also present in
the white and black female populations (Tables 1A and
2A and Figure 1 at the point where the 1968-72 and
1972-76 curves cross each other).
In black males, the risk of SLE mortality is also
low, the peak rates not exceeding 0.7 deaths per 100,000
population (Table 2A). For both white and black females, the mortality rate pattern differs, rising steeply
after puberty, and increasing even more sharply in the
case of black females (Figure 1). Black women reach
their peak SLE mortality rate at age 40 to 50 (3.8 deaths
per 100,000 population), whereas peak mortality in
white women occurs much later in life, at age 70 to 80
(1.1 deaths per 100,000).
A comparison of the two periods, 1968 through
mid-1972 and 1972-76, also shows that the race differences are even more pronounced in the latter period, especially among females. As seen in Table 1, the female
black-to-white race ratios of SLE mortality rates are
higher in 1972-76, particularly in the younger age
groups, as compared to the previous period. The female-to-male ratios for various age groups show greater
stability for whites than for blacks (Table l), possibly
because the ratios for whites are based on larger numbers: the total number of U.S. deaths from SLE among
white persons from 1968 to 1976 was 5,322, contrasted
to 1,935 deaths among blacks.
DISCUSSION
The basic SLE mortality patterns observed for
1972 to 1976 (i.e., the variable sex ratio and greater
overall mortality rates among blacks, especially among
females during early or middle adulthood) resemble
those reported for earlier periods (2,3). Indeed, the most
striking aspect of this comparative analysis is the confirmation of individual race-sex patterns by age. In their
report, Kaslow and Masi suggest that these mortality
rates mirror the incidence and prevalence rates of SLE.
Table 1. Age specific sex and race ratios of SLE mortality rates in the US.,1968 to 1972 and 1972 to
1976
Blacklwhite race ratios
Females
Age groups 1968-72'
1-4
5-9
10-14
15-19
20-24
24-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-85+*
1.7f
2.9
3.4
4.0
3.6
4.0
3.6
3.8
5.7
3.4
1.6
1.4
-
Female/male sex ratios
Males
1972-76
3.0t
4.8
6.7
5.2
4.5
5.4
4.8
5.3
3.8
3.1
2.3
1.3
-
1968-72'
3.lt
2.7t
2.1
2.1
3.0
5.1
4.4
3.5
2.1
0.8t
1.1
0.9
-
Blacks
1968-72'
1972-76
3.0t
2.0
3.7
3.3
5.8
4.5
2.0
1.8
2.0
3.O
0.lt
4.0t
5.6t
7 .O
8.1
10.5
4.7
5.8
6.0
8.7
13.2t
3.3
3.1
-
6.0t
6.3t
15.5
7.8
9.5
10.8
3.9
13.0
9.2
5.4
2.8
24.8t
-
* From Kaslow and Masi (2).
t Based on less than 5 cases in any category.
*
Whites
1972-76
Two few cases (4
to
)
compute ratios in this age group.
-
1968-72'
7.5t
5.1
4.3
4.2
8.6
5.9
7.1
5.6
3.2
3.2
2.2
2.0
-
1972-76
4.0
4.6
5.5
7.0
11.5
3.7
4.9
4.4
3.5
3.8
2.0
-
SLE MORTALITY RATES
For example, the slower and prolonged increase with
age of the male SLE mortality rate is consistent with incidence data and probably reflects later occurrence,
rather than factors associated with survival (2). Similarly, in a study at the Kaiser-Pennanente Medical Center in San Francisco between 1965 and 1973 (lo), a preponderence of SLE in black females was reported.
Based on a mean membership of 121,444 persons enrolled in the Kaiser Foundation Health Plan during the
8-year period of the study, the prevalence of SLE was 1
case per 1,969 persons; for black women aged 15-64
years, the prevalence was 1 case per 245 persons. Fessel
states that black people develop “lupus,” whether systemic or chronic discoid, three times as frequently as
their representation in the general population. These
morbidity patterns support the black-to-white mortality
rate ratios described herein.
It is of interest that the age-adjusted mortality
rates appear to have decreased in recent years in
younger age groups (1-49 years old) in each sex and
race. Also, in white females there appears to be an overall increase in the adjusted death rates in the older age
groups. In trying to explain these trends downward and
upward in age-adjusted death rates, we should note the
several factors operating here. First, these trends occurred during a period when improved diagnostic criteria and earlier diagnosis of the disease were evident.
With use of the antinuclear antibody test, patients are
diagnosed earlier in the course of the disease, and
milder forms are also recognized. Thus the increased
prevalence of the disease should result in decreasing the
case-fatality rate (defined as the number of deaths per
100 diagnosed cases) and would also possibly increase
the mortality rate (defined as the number of deaths per
100,000 population).
However, concurrent with the increased prevalence of the diagnosis, there also occurred improvement
in therapy. The increasing use of immunosuppressive
drugs to stop the progression of kidney involvement improved prognosis (11). More effective therapy should result in decreasing both the case-fatality rate and the
mortality rate, especially in the younger population in
whom renal damage may be prevented.
The decline in mortality from SLE in the
younger age groups could conceivably reflect a decline
in prevalence or incidence of the disease in younger persons, but there are no data to support this theory. It
more than likely represents a true decline in mortality
due to improved therapy. Walravens and Chase (1 1)
suggest that deaths in the younger age groups are commonly due to infections which are now easier to treat. In
the older age groups, SLE deaths more commonly result
765
from kidney or cerebrovascular complications which
are more difficult to treat. This suggests that the increased mortality in older white women is probably the
result of improved identification of SLE in the elderly.
Regarding the midlife peak mortality from SLE
seen in black women between the ages of 25 and 50, one
might speculate that either early diagnosis and/or
proper therapy are being denied to young blacks. The
observation that a similar midlife peak mortality and
subsequent drastic reduction in mortality rate is not
seen for whites is interesting, but not readily explained.
ACKNOWLEDGMENTS
The authors gratefully acknowledge Drs. Alfonse T.
Masi and Randall D. Cebul for critical comments offered during the preparation of this manuscript. Special thanks are also
due to Joan Davies, Keith Soper, and Marian Weston for statistical advice, and to the National Center for Health Statistics
which promptly supplied us with computer printouts containing all the raw data used in this report. The authors also wish
to express their appreciation to Melodye Thompkins for her
expertise in the typing of the manuscript.
REFERENCES
1. Masi AT, Kaslow RA: Sex effects in systemic lupus erythematosus: a clue to pathogenesis. Arthritis Rheum
21:480, 1978
2. Kaslow RA, Masi AT: Age, sex and race effects on mortality from systemic lupus erythematosus in the United
States. Arthritis Rheum 21:473479, 1978
3. Cobb S: The Frequency of the Rheumatic Diseases. Cambridge, Harvard University Press, 1971
4. Talal N: Systemic lupus erythematosus, autoimmunity,
sex and inheritance. N Engl J Med 301(15):838, 1979
5. Purtilo DT, Sullivan JL: Immunological bases for superior survival of females. Am J Dis Child 133:1251, 1979
6. Roubinian JR, Papoian R, Talal N: Androgenic hormones modulate antibody responses and improve survival
in murine lupus. J Clin Invest 59: 1066-1070, 1977
7. Melez KA, Reeves JP, Steinberg AD: Regulation of the
expression of autoimmunity in NZB X NZW F, mice by
sex hormones. J Immuno-Pharmacol 1:2742, 1978-79
8. Siege1 M, Lee SL: The epidemiology of systemic lupus
erythematosus: results of a population study in New York
City, Population Studies of the Rheumatic Diseases. New
York, Excerpta Medica Foundation, 1968, pp 245-25 1
9. U.S. Bureau of the Census: Current population reports,
series P-25, #721; estimates of the population of the U.S.
by age, sex and race: 1970 to 1977. U.S. Government
Printing Office, Washington DC, 1978, p 20
10. Fessel I: Systemic lupus erythematosus in the community.
Arch Intern Med 134:1027-1035, 1974
11. Walravens PA, Chase P: The prognosis of childhood systemic lupus erythematosus. Am J Dis Child 130:929-933,
1976
GORDON ET AL
766
APPENDIX A
Table 1A. Age-specific mortality rates for systemic lupus erythematosus in white males and white
females, 1968-72 and 1972-76, in the U.S. (per million person-years)
1968- 1972
us.
Age
White males
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
4549
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Overall crude
rates
Overall adjusted
rates+
White females
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Overall crude
rates
Overall adjusted
rates*
population
1970*
No. of
deaths
5,891
8,658
9,058
8,317
6,97 1
5,872
4,943
4,799
5,209
5,221
4,843
4,320
3,656
2,815
2,112
1,440
808
443
0
2
12
33
44
21
24
22
33
48
51
68
69
45
40
34
10
85,426
56 I
5
1972- 1976
Average
annual
mortality
ratest
population
1974*
No. of
deaths
0.1
0.3
0.9
1.4
0.8
1.1
1.o
1.4
2.0
2.3
3.5
4.2
3.6
4.2
5.2
2.8
2.5
5,650
7,527
8,948
8,971
8,Ol I
7,078
5,854
4,903
4,904
5,129
5,177
4,465
3,881
3,126
2,194
1,423
868
523
1
0
8
21
25
23
13
31
28
25
44
49
89
71
53
41
16
1
0.04
0.2
0.5
0.6
0.6
0.4
1.3
1.1
I .4
1.7
2.2
4.6
4.5
4.8
5.8
3.7
0.4
I .46
89,9 14
550
1.22
us.
1.48
5,63 1
2,887
8,670
8,101
7,363
5,982
5,059
4,952
5,428
5,600
5,179
4,704
4,165
3,492
2,879
2,118
1,316
850
0
5
5.9
137
195
184
146
161
192
165
173
166
158
137
111
66
32
9
89,761
2,096
Average
annual
mortality
ratest
I .23
0.4
1.5
3.8
5.9
6.8
6.4
7.2
7.9
6.5
7.4
7.8
8.4
8.7
8.6
6.9
5.4
2.4
5,389
7,202
8,554
8,705
7,974
7,077
5,929
5,07 1
5,048
5,400
5,544
4,873
4,419
3,928
3,032
2,206
1,529
1,073
1
6
35
102
131
147
137
122
135
169
166
202
208
185
168
104
67
30
0.04
0.2
0.8
2.3
3.3
4.2
4.6
4.8
5.4
6.2
6.0
8.3
9.4
9.4
11.1
9.4
8.8
5.6
5.18
94,169
2,115
4.49
5.42
4.62
* Population in thousands.
f Mortality rates per million person-years. Kaslow and Masi's calculations of mortality rates are based
on 100% sample of deaths for 1968-71 and 50% sample of 1972 deaths (i.e., the multiple factor in the
denominator is 4.5 years). Calculations of mortality rates for 1972-76 are based on 100% sample of 197276 deaths (i.e., the multiple factor in the denominator is 5 years).
Adjusted by the direct method, using the combined populations of 1970 and 1974 as the standard.
*
SLE MORTALITY RATES
767
Table 2A. Age-specific mortality rates for systemic lupus erythematosus in black males and black
females, 1968-72 and 1972-76, in the U.S. (per million person-years)
1968- 1972
U.S.
Age
population
1970'
No. of
deaths
Black males
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
4044
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Overall crude
rates
Overall adjusted
rates+
976
1,379
1,408
1,203
84 1
658
569
54 1
544
52 1
459
405
335
277
184
110
59
39
10,508
0
1
5
10
11
7
14
11
12
10
4
7
6
4
2
I
I
0
106
Overall crude
rates
Overall adjusted
rates*
0.2
0.8
1.8
2.9
2.4
5.5
4.5
4.9
4.3
1.9
3.8
4.0
3.2
2.4
2.0
3.8
-
2.24
us.
population
1974'
1,130
1,432
1,615
1,538
1,206
914
780
639
637
61 1
580
447
416
347
217
13 I
85
57
13,040
No. of
deaths
1
1
5
8
13
9
9
19
7
8
10
15
1
8
3
1
2
1
I22
61
27
22
16
2
4
3
0
0.6
4.4
12.9
23.5
24.8
25.9
26.1
29.5
37.2
25.5
12.8
12.2
10.2
1.9
6. I
7.8
-
1,114
1,424
1,600
1,548
1,333
1,070
92 1
78 1
763
706
663
514
484
439
259
173
I26
98
4
30
120
I14
101
I14
89
109
84
61
49
30
17
10
10
2
0
772
14.80
14,226
93 5
97 1
1,372
1,405
1,223
975
77 1
686
656
655
603
532
469
400
350
232
145
85
63
0
4
28
71
103
86
80
77
87
11.593
101
15.10
Average
annual
mortality
ratest
0.2
0.1
0.6
1.o
2.2
2.0
2.3
5.9
2.2
2.6
3.4
6.7
0.5
4.6
2.8
1.5
4.7
3.5
1.87
1.87
2.41
Black females
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
1972-1976
Average
annual
mortality
ratest
1
0.2
0.6
3.8
15.5
17. I
18.9
24.8
22.8
28.6
23.8
18.4
19.I
12.4
7.7
7.7
11.6
3.2
-
13.1 1
13.32
* Population in thousands.
f Mortality rates per million person-years. Kaslow and Masi's calculations of mortality rates are based
on 100% sample of deaths for 1968-71 and 50% sample of 1972 deaths (i,e,, the multiple factor in the
denominator is 4.5 years). Calculations of mortality rates for 1972-76 are based on 100% sample of 197276 deaths (i.e., the multiple factor in the denominator is 5 years).
Adjusted by the direct method, using the combined populations of 1970 and 1974 as the standard.
+
GORDON ET AL
768
APPENDIX B
Table 1B. Deaths from SLE in white males and age-specific trends in age-adjusted death rates, 1968 through 1977, in the U.S. (Adjusted to the
age distribution of the U.S. population, 1970)
White males
Ages 1-49
Year
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
Population
(in 1000s)
No. of
deaths
64,018
64,440
65,406
65,757
66,363
66,737
66,976
67,171
67,393
67,546
55
77
40
49
32
39
41
36
33
38
Spearman’s rank order
correlation coefficient
Two-tailed test (n = 10)
Ages 50-80+
SE of
Age-adjusted
death rates adjusted rates
per 100,000 per 100,000
0.09
0.12
0.06
0.07
0.05
0.06
0.06
0.05
0.05
0.05
0.012
0.014
0.010
0.010
0.010
0.010
0.010
0.010
0.010
0.010
Population
(in 1000s)
No. of
deaths
20,015
20,242
20,488
20,800
21,105
21,371
21,650
21,944
22,2 18
22.487
73
68
66
79
72
68
85
73
69
91
rs = -0.75
P < 0.02
Age-adjusted
SE of
death rates adjusted rates
per 100,000 per 100,000
0.36
0.34
0.32
0.38
0.34
0.32
0.39
0.32
0.3 1
0.38
0.043
0.04 1
0.040
0.043
0.040
0.040
0.043
0.040
0.040
0.041
rs = -0.08
Not significant
Table 2B. Deaths from SLE in white females and age-specific trends in age-adjusted death rates, 1968 through 1977, in the U.S. (Adjusted to the
age distribution of the US.population, 1970)
White females
Ages 1-49
Year
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
Spearman’s rank order
correlation coefficient
Two-tailed test (n = 10)
Population
(in 1000s)
No. of
deaths
64,351
64,735
65,433
65,577
65,947
66,214
66,37 1
66,456
66,639
66,822
308
305
259
269
206
217
171
188
203
208
Ages 50-80+
Age-adjusted
SE of
death rates adjusted rates
per 100,000 per 100,000
0.48
0.47
0.40
0.39
0.31
0.32
0.25
0.27
0.29
0.30
r, = -0.87
P < 0.002
0.03 1
0.030
0.025
0.024
0.021
0.022
0.020
0.02 1
0.02 1
0.021
Population
(in 1000s)
No. of
deaths
23,872
24,324
24,608
25,265
25,729
26,158
26,596
27,037
27,448
27,837
182
181
190
21 1
172
217
245
216
276
250
Age-adjusted
SE of
death rates adjusted rates
per 100,000 per 100,OOO
0.76
0.74
0.77
0.84
0.68
0.83
0.92
0.80
1.01
0.90
r, = 0.7 1
P < 0.02
0.060
0.055
0.056
0.061
0.052
0.060
0.060
0.055
0.06 I
0.057
SLE MORTALITY RATES
769
Table 3B. Deaths from SLE in black males and age-specific trends in age-adjusted death rates, 1968 through 1977, in the U.S. (Adjusted to the
age distribution of the U.S.population, 1970)
Black males
Ages 1-49
Year
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
Population
(in 1000s)
No. of
deaths
9,348
9,519
9,903
9,916
10,138
10,315
10,495
10,714
10,915
1 1,090
21
22
18
19
14
21
14
16
15
24
Spearman’s rank order
correlation coefficient
Two-tailed test (n = 10)
Ages 50-80+
SE of
Age-adjusted
death rates adjusted rates
per 100,000 per 100,OOO
0.22
0.22
0.18
0.18
0.13
0.19
0.13
0.14
0.12
0.19
0.050
0.050
0.043
0.042
0.040
0.042
0.034
0.040
0.032
0.040
Population
(in 1000s)
No. of
deaths
2,026
2,054
1,996
2,142
2,186
2,232
2,279
2,335
2,390
2,443
7
5
4
7
10
8
10
5
8
9
rs = -0.35
Not significant
Age-adjusted
SE of
death rates adjusted rates
per 100,000 per 100,000
0.36
0.24
0.20
0.33
0.44
0.37
0.46
0.23
0.34
0.37
0.135
0.110
0.100
0.125
0.140
0.133
0.147
0.101
0.119
0.125
rs = 0.3 1
Not significant
Table 4B. Deaths from SLE in black females and age-specific trends in age-adjusted death rates, 1968 through 1977, in the U.S. (Adjusted to the
age distribution of the U.S. population, 1970)
Black females
Ages 1 4 9
Year
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
Spearman’s rank order
correlation coefficient
Two-tailed test (n = 10)
Population
(in 1000s)
No. of
deaths
10,048
10,240
10,474
10,642
10,859
11,059
11,253
1 1,485
11,712
11.892
138
165
136
174
166
142
145
133
170
130
Ages 50-80+
Age-adjusted
SE of
death rates adjusted rates
per 100,000 per 100,OOO
r, = -0.80
P c 0.01
1.58
1.58
1.30
1.57
1.46
1.22
1.22
I .07
1.33
1.00
0.126
0.123
0.111
0.119
0.113
0.103
0.101
0.100
0.103
0.110
Population
(in 1000s)
No. of
deaths
2,355
2,415
2,362
2,546
2,613
2,686
2,757
2,839
2,88 1
2,999
22
29
41
43
22
41
34
41
41
48
Age-adjusted
SE of
death rates adjusted rates
per 100,000 per 100,000
0.92
1.21
1.74
1.72
0.83
1.58
1.25
1.48
I .49
1.66
rr = 0.25
Not significant
0.197
0.226
0.27 I
0.263
0.178
0.248
0.214
0.232
0.233
0.241
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