Project Details
Description
PROJECT SUMMARY
Knowledge about lupus is biased towards the severe end of the disease spectrum due to difficulty assembling
population-based cohorts of persons with lupus. An urgent need to expand the basic epidemiologic
understanding of cutaneous and systemic lupus in four content areas (i.e., natural history, treatment, health
care access, and disparities) was identified by the Centers for Disease Control and Prevention. Our project
addresses these needs using the unique research infrastructure of the Rochester Epidemiology Project (REP),
which contains longitudinal data on residents of a 27-county region in Minnesota and Wisconsin. We have
assembled population-based cohorts comprised of persons with prevalent and incidence systemic lupus
erythematosus (SLE) and cutaneous lupus erythematosus (CLE) matched to general population comparators
without SLE/CLE by sex, age, race/ethnicity, and county of residence. These cohorts comprise the Lupus
Midwest Network (LUMEN). Through the REP infrastructure, LUMEN follows individuals regardless of
insurance status and encompasses the full spectrum of care, from primary care clinics to tertiary specialty
care, and maintains an electronic index of diagnoses and procedures, including all inpatient and outpatient
encounters, laboratory measures, and drug prescription data. In this competitive renewal of a highly successful
grant investigating multimorbidity in SLE and CLE, opioid pain therapy, and healthcare access and gaps, our
team of researchers and clinicians with decades of experience conducting population-based research will now
focus on new research questions designed to have a high public health impact and to leap forward in our
understanding of the natural history, treatment, healthcare access, and disparities across the full spectrum of
CLE and SLE. Using the LUMEN population-based cohorts, we aim to 1) determine the contributions of lupus
nephritis (LN) and anti-phospholipid syndrome (APS) to the excess mortality and unplanned healthcare
utilization (i.e., emergency department visits and hospitalizations) among patients with SLE; 2) determine the
contribution of LN to the excess risk of cardiovascular disease (myocardial infarction and stroke), infections,
and osteoporosis among patients with SLE; 3) determine access to SLE-specific screening services and
patterns of glucocorticoid use by social determinants of health, age, sex, and race/ethnicity; and 4) determine
the transition rates over time and risk factors for transition from CLE to SLE over four decades to test the
hypothesis that a) most transitions from CLE to SLE occur within five years of the CLE diagnosis, and b) oral
contraceptives or postmenopausal hormone use increase the risk of transitioning from CLE to SLE. These
projects will inform the individualized prognostication of SLE in clearly defined disease phenotypes and inform
interventions to optimize patient care, prevent or reduce adverse outcomes in patients with lupus, and will
identify a window of opportunity in CLE for therapeutic interventions to prevent the transition to SLE.
Status | Active |
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Effective start/end date | 9/30/22 → 9/29/24 |
Funding
- National Center for Chronic Disease Prevention and Health Promotion: $900,000.00
- National Center for Chronic Disease Prevention and Health Promotion: $900,000.00
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