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Prevalence of Systemic Lupus Erythematosus and Coexisting Autoimmune Diseases in Puerto Rico in the Context of Hurricane Maria and the COVID-19 Pandemic

Casey K. Gilman* Evián Pérez Rivera, Alexandra Rincones, Melyorise Sepúlveda Chervony, Johanna Lee, Alan Marquez, Christian Castilla, Michelle Santiago, Ada Cortes

Background: Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease that tends to coexist with other autoimmune conditions. The prevalence and etiology of the concurrent autoimmune diseases of SLE patients remains unknown. In Puerto Rico (PR) the prevalence of SLE was last reported in 2007 as a striking 159 per 100,000 individuals. The purpose of this investigation is to provide an updated prevalence of SLE and its autoimmune comorbidities in Puerto Rico in the setting of Hurricane Maria and the COVID-19 pandemic.

Methods: Patient record information from the Puerto Rico Health Insurance Administration (PRHIA) was used to identify individuals with SLE between the years 2018 through 2020. Demographic characteristics such as age and sex were recorded. In addition, medications and comorbidities were evaluated. Prevalence was estimated.

Results: A total of 12,918 cases of SLE were analyzed. Prevalence was estimated to be 536 per 100,000 individuals at its peak in 2019. In individuals with SLE, 3.6% had at least 1 additional autoimmune diagnosis. Patients who were female, aged 35 to 54, or with a record of using corticosteroids within the past three years were identified as more likely to be affected by an additional autoimmune disease.

Conclusion: Our findings reveal an increased prevalence of SLE as compared to previous studies in both the United States and Puerto Rico. We also contributed to limited literature on the co-occurence of SLE with other autoimmune diseases and its associated factors.