Characterizing the increasing trend of childhood-onset systemic lupus erythematosus in Bali and neighbouring provinces: Results of the Bali Paediatric Systemic Lupus Erythematosus Database (BEATLES) study

Abstract

Background

Mounting evidence indicates an increase in systemic lupus erythematosus (SLE) cases in the paediatric population, highlighting childhood-onset SLE (cSLE) as a distinct entity that warrants attention. Thus, we characterized a hospital-based cSLE patient cohort at our centre, including 10 years of observation and an assessment of case distribution across three subperiods.

Methods

Retrospective data from 2009 to 2022 were collected from the hospital medical records of SLE patients <18 years at the Department of Child Health at Prof. Ngoerah Hospital in Denpasar. The 2009–2022 population estimation was derived from the Office of Statistic Bureau, Bali Branch. We documented the number across the 2009–2022 period, the incidence per year, the regency of origin, the patients’ age and sex, the number of referral cases, and the referrer and referrer diagnosis. The patients were grouped by year of presentation; the subperiods 2009–2014 (1st period), 2015–2017 (2nd period), and 2018–2022 (3rd period) were selected according to changes in financial and facility management across the study period. The distribution of certain characteristics across the subperiods was also assessed.

Results

A single case of cSLE was documented in 2009, followed by a pause in new cases. Subsequently, the incidence slowly increased until 2014. A surge in case numbers was reported from 2015 to 2017. The case incidence peaked in 2019, then began to decline, only to increase again in 2022. Thus, across the 2009–2022 period, the two peaks with the sharpest trend increases occurred between 2009 and 2019. The most common regency of origin was Denpasar in the first period, Badung in the second, and Denpasar in the third. Referrals also originated from other provinces in the third period. The dominant age group in the first period was 6–11 years, while the second and third periods were dominated by those 12–18 years of age, followed by 6–11 years, with a small number <5 years. No differences in the sex ratio were observed across the periods.

Conclusion

cSLE demonstrates an increasing trend in Bali, underscoring the need for improved facilities for diagnosis, medication, and care at both the acute and long-term disease phases.