Americans with Lupus Cycle In and Out of Hospitals

Lupus, a chronic autoimmune disease that causes widespread inflammation in the body, is notoriously difficult to diagnose and treat. Many lupus patients end up in the hospital, and not just once.

One out of every six patients with systemic lupus erythematosus (SLE) in the U.S. was readmitted within one month of being discharged from the hospital, according to a multi-state study of more than 55,000 hospitalizations at 810 hospitals. These early readmissions were more common among black and Hispanic patients, as well as Medicaid and Medicare patients.

"SLE patients have one of the highest hospital readmission rates compared to those with other chronic illnesses," said the study’s lead author, Dr. Jinoos Yazdany, from the Division of Rheumatology at the University of California, San Francisco (UCSF), in a press statement. "Our study is the first large-scale examination of early readmissions following hospitalization due to SLE."

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17 Percent of Lupus Patients Face Early Readmission

In the study, published online today in the journal Arthritis & Rheumatology, researchers looked at 2008 and 2009 data from hospital discharge databases for 810 hospitals, or 85 percent of all hospitals in the U.S. 

In order to focus on readmissions, the researchers excluded patients who had been transferred to other hospitals, discharged to a rehabilitation or nursing facility, or died during the initial admission.

Researchers found that within 30 days of discharge, 16.5 percent of SLE patients were readmitted to the hospital. These patients tended to be younger, female, from a racial or ethnic minority group, and on a Medicare or Medicaid health insurance plan, compared to those with private insurance. The authors speculated that younger patients were more likely to be readmitted because their disease involved more severe organ inflammation.

More than 140,000 people with SLE — up to 25 percent of SLE patients — are hospitalized each year in the U.S. People with SLE can end up in the hospital due to symptoms of the condition itself, infections, or related medical conditions. Readmissions for SLE are the sixth highest of any medical condition in the U.S.

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Complex Nature of Lupus Makes Treatment a Challenge

The UCSF researchers found that certain medical problems were common among SLE patients who were readmitted within 30 days, including kidney inflammation, inflammation of the lining of the abdomen, heart, lungs, or abdominal organs, and low blood platelet count.

Researchers also noticed a great deal of variation both among hospitals and in different areas of the country. For example, compared to California, New York had fewer early readmissions for SLE, while Florida had more. 

But hospitals with a greater number of readmissions for SLE patients did not have similarly high readmission rates for other conditions, such as heart failure or pneumonia. This indicates that the problem may not be with the hospital’s overall quality of care, but instead with the complex treatment required for lupus. Lupus can affect many areas of the body, including the joints, kidneys, and other organs.

In their paper, the authors are careful to note that the study is not intended to grade hospitals on how well they treat lupus. Instead, they hope that identifying groups of patients most affected by early readmissions will highlight the need for better overall treatment of this tricky condition, including managing the patient’s care during the transition out of the hospital.

"The significant geographic and hospital-level variation in readmission rates signals a need for quality improvement efforts in lupus,” Yazdany said.

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