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SLE patients (identified by ICD\u20109\u2010CM: 695.4, 710.0, and ICD\u201010\u2010AM: L93.0, M32.0) were nearest matched (10:1) for age, sex, Aboriginality, and temporality. Follow up was from time zero (index SLE hospitalization) to cancer development, death or 31 December 2014. We assessed the risk of cancer development and subsequent 5\u2010year mortality between SLE patients and comparators with univariate and multivariate\u2010adjusted Cox proportional hazards regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>SLE patients had similar multivariate\u2010adjusted risk (adjusted hazard ratio [aHR] 1.03, 95% confidence interval [CI] 0.93\u20131.15; <jats:italic>p<\/jats:italic>\u2009=\u2009.583) of cancer development. Cancer development risk was higher in SLE patients &lt;40\u2009years old (aHR 1.58, 95% CI 1.29\u20131.94; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), and from 1980 to 1999 (aHR 1.16, 95% CI 1.02\u20131.31; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). SLE patients had higher risk of developing cancer of the oropharynx (aHR 2.13, 95% CI 1.30\u20133.50), vulvo\u2010vagina (aHR 3.22, 95% CI 1.34\u20137.75), skin (aHR 1.20, 95% CI 1.01\u20131.43), musculoskeletal tissues (aHR 2.26, 95% CI 1.16\u20134.40), and hematological tissues (aHR 1.78 95% CI 1.25\u20132.53), all <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05. After cancer development, SLE patients had increased risk of 5\u2010year mortality (aHR 1.31, 95% CI 1.06\u20131.61); highest in patients &lt;50\u2009years old (aHR 2.03, 95% CI 1.03\u20134.00), and in those with reproductive system and skin cancers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hospitalized SLE patients had increased risk of multiple cancer sub\u2010types. Following cancer development, SLE patients had increased risk of 5\u2010year mortality. There is scope to improve cancer prevention and surveillance in SLE patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration<\/jats:title><jats:p>Not applicable. 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