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3 hours ago
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Black patients are eight times more likely to be admitted to hospital with lupus than their white counterparts, NHS figures show, with experts saying the “stark” inequality could be a result of delayed diagnoses.
The hospital admission rate in England for black patients with a primary diagnosis of lupus was 62.6 per 100,000 in 2023/24, while there were 7.8 admissions per 100,000 for white people. Asian patients also had an increased rate of hospitalisation, with 26 admissions per 100,000.
Systemic lupus erythematosus (SLE), commonly referred to as lupus, is a chronic autoimmune disease that develops when the immune system attacks the body’s healthy tissues and organs. Its symptoms, which can be severe, include extreme fatigue, anaemia and major organ failure.
The overall number of people with lupus being treated in hospital has risen by almost 50% over the past four years, from 6,334 admissions in 2019-20, to 8,006 admissions in 2023-24. The data refers to finished admission episodes where lupus was the primary diagnosis.
About one in 1,000 people in the UK have lupus, 90% of them women, with people from minority ethnic backgrounds at a disproportionate risk of the disease. However, this increased risk is not enough to justify the stark disparity in the hospitalisation rates, several academics say.
Angela Davison, at the Lupus Trust, said the disparity may be because of late diagnoses, which leads to more severe symptoms. “These stark figures highlight how, despite lupus being much more prevalent in certain ethnic groups such as African, African-Caribbean and Asian, there is often far less awareness of it among these groups, which also contributes to a delay in diagnosis,” she said.
“We need more people to know about lupus and its symptoms and, in particular, for doctors to be familiar with it – specifically GPs as this is the first doctor that people will usually visit when symptoms appear.”
Dr Faye Ruddock, the chair of the Caribbean and African Health Network, said that the testimonies and experiences of black patients with lupus highlighted the inadequate care, support and treatment for black women with the condition.
“There are significant determining factors that exacerbate the multiple organs affected in SLE such as racism, poor housing, poor healthcare and access to services, with later referral for appropriate treatment and care. All of these ongoing challenges lead to an eightfold higher rate of hospitalisation and the likelihood of black women dying from the condition,” Ruddock said.
She added: There is an urgent need to focus on ways to address this inequity that is affecting the lives of many black people, their families, society and the economy. The 10-year plan should identify through the health inequalities and prevention agenda new ways of working with underserved communities to reduce risk and hospitalisation and with this build in the resource required to shift the dial.”
Prof Anisur Rahman, a consultant rheumatologist at University College Hospital and a professor of rheumatology at UCL, said: “Lupus occurs more commonly in black and Asian people than white people but this alone would not explain the increased hospitalisation in those groups. Research in the UK and elsewhere has suggested that lupus may be worse in black and Asian patients, which could lead them to become more ill from the disease and require hospitalisation.
“Although we know that SLE occurs more commonly in black and Caribbean ethnic groups than white people, this is not sufficient to explain all the difference in levels of hospitalisation.”
He added that it was still unclear why the prevalence of lupus was much higher in people from minority ethnic backgrounds, calling for more research into the disparity. “Although it is assumed to be genetic in origin, there are no specific genes which can explain it, in comparison to other diseases which can be attributed to specific genes such as sickle cell disease.”
Prof David D’Cruz, a consultant rheumatologist at Guy’s hospital, said the higher rate of hospital admission for black patients was “concerning”, and might be an indication of black patients experiencing more severe symptoms of the disease.
“Although there have been advances in the early diagnosis and treatment of patients with SLE, this data suggests that there is a significant unmet need to improve disease activity, prevent disease flares and reduce the rate of hospital admissions,” D’Cruz said. “The assumption is that disease flares [which occur when symptoms get worse] requiring hospital admission can increase the risk of damage accumulation, which is known to increase the risk of morbidity and premature mortality.”
An NHS spokesperson said: “The causes of lupus are not fully understood but we know it is better managed and treated if found early, so anyone concerned that they may be experiencing symptoms should contact their GP in the first instance.”
