{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:06:48Z","timestamp":1790996808904,"version":"4.1.0"},"reference-count":42,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T00:00:00Z","timestamp":1676505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["2019-I2M-2\u2013008"],"award-info":[{"award-number":["2019-I2M-2\u2013008"]}]},{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["2021-I2M-1\u2013005"],"award-info":[{"award-number":["2021-I2M-1\u2013005"]}]},{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["2021YFC2501300"],"award-info":[{"award-number":["2021YFC2501300"]}]},{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["Z201100005520022,23, 25\u201327"],"award-info":[{"award-number":["Z201100005520022,23, 25\u201327"]}]},{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["2022-PUMCH-B-013"],"award-info":[{"award-number":["2022-PUMCH-B-013"]}]},{"name":"Chinese National Key Technology R&amp;D Program, Ministry of Science and Technology","award":["2019-I2M-2\u2013008"],"award-info":[{"award-number":["2019-I2M-2\u2013008"]}]},{"name":"Chinese National Key Technology R&amp;D Program, Ministry of Science and Technology","award":["2021-I2M-1\u2013005"],"award-info":[{"award-number":["2021-I2M-1\u2013005"]}]},{"name":"Chinese National Key Technology R&amp;D Program, Ministry of Science and Technology","award":["2021YFC2501300"],"award-info":[{"award-number":["2021YFC2501300"]}]},{"name":"Chinese National Key Technology R&amp;D Program, Ministry of Science and Technology","award":["Z201100005520022,23, 25\u201327"],"award-info":[{"award-number":["Z201100005520022,23, 25\u201327"]}]},{"name":"Chinese National Key Technology R&amp;D Program, Ministry of Science and Technology","award":["2022-PUMCH-B-013"],"award-info":[{"award-number":["2022-PUMCH-B-013"]}]},{"name":"Beijing Municipal Science &amp; Technology Commission","award":["2019-I2M-2\u2013008"],"award-info":[{"award-number":["2019-I2M-2\u2013008"]}]},{"name":"Beijing Municipal Science &amp; Technology Commission","award":["2021-I2M-1\u2013005"],"award-info":[{"award-number":["2021-I2M-1\u2013005"]}]},{"name":"Beijing Municipal Science &amp; Technology Commission","award":["2021YFC2501300"],"award-info":[{"award-number":["2021YFC2501300"]}]},{"name":"Beijing Municipal Science &amp; Technology Commission","award":["Z201100005520022,23, 25\u201327"],"award-info":[{"award-number":["Z201100005520022,23, 25\u201327"]}]},{"name":"Beijing Municipal Science &amp; Technology Commission","award":["2022-PUMCH-B-013"],"award-info":[{"award-number":["2022-PUMCH-B-013"]}]},{"name":"National High Level Hospital Clinical Research Funding","award":["2019-I2M-2\u2013008"],"award-info":[{"award-number":["2019-I2M-2\u2013008"]}]},{"name":"National High Level Hospital Clinical Research Funding","award":["2021-I2M-1\u2013005"],"award-info":[{"award-number":["2021-I2M-1\u2013005"]}]},{"name":"National High Level Hospital Clinical Research Funding","award":["2021YFC2501300"],"award-info":[{"award-number":["2021YFC2501300"]}]},{"name":"National High Level Hospital Clinical Research Funding","award":["Z201100005520022,23, 25\u201327"],"award-info":[{"award-number":["Z201100005520022,23, 25\u201327"]}]},{"name":"National High Level Hospital Clinical Research Funding","award":["2022-PUMCH-B-013"],"award-info":[{"award-number":["2022-PUMCH-B-013"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: To estimate the annual direct costs and cost-drivers associated with systemic lupus erythematosus (SLE) patients in China. Methods: A multi-center, cross-sectional study was conducted based on the CSTAR registry. The information on demography and expenditures for outpatient and inpatient visits due to SLE were collected using online questionnaires. These patients\u2019 medical records were from the database of the Chinese Rheumatology Information System (CRIS). The average direct costs and 95% confidence interval were estimated using the bootstrap method with 1000 bootstrap samples by resampling with replacement. The cost-drivers were identified using multivariate regression models. Results: A total of 1778 SLE patients from 101 hospitals participated in our study, with 92.58% as females, a mean age of 33.8 years old, a median duration of SLE of 4.9 years, 63.8% in an active disease state, 77.3% with two organs or more damaged, and 8.3% using biologics as treatment. The average annual direct cost per patient was estimated at CNY 29,727, which approximates to 86% for direct medical costs. For moderate to severe disease activities, the use of biologics, hospitalization, treatment of moderate or high dose glucocorticoids, and peripheral vascular, cardiovascular, and\/or renal system involvements were found to substantially increase the direct costs, while health insurance slightly decreased the direct costs of SLE. Conclusions: This study provided reliable insight into financial pressures on individual SLE patients in China. The efforts focusing on preventing flare occurrences and limiting disease progression were recommended to further reduce the direct cost of SLE.<\/jats:p>","DOI":"10.3390\/ijerph20043522","type":"journal-article","created":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T01:59:24Z","timestamp":1676599164000},"page":"3522","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Annual Direct Cost and Cost-Drivers of Systemic Lupus Erythematosus: A Multi-Center Cross-Sectional Study from CSTAR Registry"],"prefix":"10.3390","volume":"20","author":[{"given":"Haiyan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengtao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiwen","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoling","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiuliang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanyuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinping","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3436-4673","authenticated-orcid":false,"given":"Yanhong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1093\/rheumatology\/kez516","article-title":"Damage accrual and mortality over long-term follow-up in 300 patients with systemic lupus erythematosus in a multi-ethnic British cohort","volume":"59","author":"Segura","year":"2020","journal-title":"Rheumatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1093\/rheumatology\/kep062","article-title":"Damage and mortality in a group of British patients with systemic lupus erythematosus followed up for over 10 years","volume":"48","author":"Chambers","year":"2009","journal-title":"Rheumatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1002\/acr.20648","article-title":"Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort","volume":"64","author":"Urowitz","year":"2012","journal-title":"Arthritis Care Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.mayocp.2019.09.012","article-title":"Sex Differences in Systemic Lupus Erythematosus: Epidemiology, Clinical Considerations, and Disease Pathogenesis","volume":"95","author":"Nusbaum","year":"2020","journal-title":"Mayo. Clin. Proc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/S0140-6736(01)05731-2","article-title":"Systemic lupus erythematosus","volume":"358","author":"Grant","year":"2001","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2478\/rir-2022-0006","article-title":"The challenges and future perspective for the management of systemic lupus erythematosus in China: A concise annual report of 2020","volume":"3","author":"Tian","year":"2022","journal-title":"Rheumatol. Immunol. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2307\/3349801","article-title":"Cost-of-illness methodology: A guide to current practices and procedures","volume":"60","author":"Hodgson","year":"1982","journal-title":"Milbank Mem. Fund Q. Health. Soc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"385","DOI":"10.3899\/jrheum.191187","article-title":"Healthcare Utilization and Costs of Systemic Lupus Erythematosus by Disease Severity in the United States","volume":"48","year":"2021","journal-title":"J. Rheumatol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Fatoye, F. (2021). Direct health system costs for systemic lupus erythematosus patients in Alberta, Canada. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0251409"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1080\/13696998.2020.1740236","article-title":"Treatment patterns and medical cost of systemic lupus erythematosus patients in Japan: A retrospective claims database study","volume":"23","author":"Miyazaki","year":"2020","journal-title":"J. Med. Econ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1007\/s00296-015-3344-8","article-title":"Direct medical costs and their predictors in South Korean patients with systemic lupus erythematosus","volume":"35","author":"Park","year":"2015","journal-title":"Rheumatol. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s40744-021-00277-0","article-title":"The Burden of Systemic Lupus Erythematosus in Germany: Incidence, Prevalence, and Healthcare Resource Utilization","volume":"8","author":"Schwarting","year":"2021","journal-title":"Rheumatol. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"rkab071","DOI":"10.1093\/rap\/rkab071","article-title":"Health-care utilization and costs in adults with systemic lupus erythematosus in the United Kingdom: A real-world observational retrospective cohort analysis","volume":"5","author":"Samnaliev","year":"2021","journal-title":"Rheumatol. Adv. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1177\/0961203316642310","article-title":"Clinical and financial burden of active lupus in Greece: A nationwide study","volume":"25","author":"Bertsias","year":"2016","journal-title":"Lupus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1093\/rheumatology\/kep031","article-title":"Systemic lupus erythematosus with neuropsychiatric manifestation incurs high disease costs: A cost-of-illness study in Hong Kong","volume":"48","author":"Zhu","year":"2009","journal-title":"Rheumatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1007\/s00296-016-3551-y","article-title":"Medical costs incurred by organ damage caused by active disease, comorbidities and side effect of treatments in systemic lupus erythematosus patients: A Taiwan nationwide population-based study","volume":"36","author":"Chiu","year":"2016","journal-title":"Rheumatol. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1002\/acr.20410","article-title":"Cost-of-illness studies in systemic lupus erythematosus: A systematic review","volume":"63","author":"Zhu","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.semarthrit.2019.11.007","article-title":"An increased disease burden of autoimmune inflammatory rheumatic diseases in Korea","volume":"50","author":"Kim","year":"2020","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"869","DOI":"10.2165\/00019053-200624090-00005","article-title":"Cost-of-illness studies: A review of current methods","volume":"24","author":"Akobundu","year":"2006","journal-title":"Pharmacoeconomics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1002\/acr.24023","article-title":"Lupus Low Disease Activity State and Reduced Direct Health Care Costs in Patients With Systemic Lupus Ery-thematosus","volume":"72","author":"Yeo","year":"2020","journal-title":"Arthritis Care Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1177\/09612033211073670","article-title":"An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States","volume":"31","author":"Bell","year":"2022","journal-title":"Lupus"},{"key":"ref_22","first-page":"375","article-title":"Clinical profile and direct medical cost of care of adults presenting with systemic lupus erythematosus in Italy","volume":"33","author":"Doria","year":"2015","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1177\/0961203315584812","article-title":"Total cost and cost predictors in systemic lupus erythematosus\u20148-years follow-up of a Swedish inception cohort","volume":"24","author":"Jonsen","year":"2015","journal-title":"Lupus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.2147\/PPA.S144624","article-title":"Treatment adherence and disease burden of individuals with rheumatic diseases admitted as outpatients to a large rheumatology center in Shanghai, China","volume":"11","author":"Zhang","year":"2017","journal-title":"Patient Prefer. Adherence"},{"key":"ref_25","first-page":"536","article-title":"Analysis of the annual direct economic burden and influencing factors of patients with systemic lupus erythematosus in Anhui province","volume":"45","author":"Huang","year":"2020","journal-title":"J. Bengbu Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"487","DOI":"10.2165\/00019053-199813050-00002","article-title":"The use of the bootstrap statistical method for the pharmacoeconomic cost analysis of skewed data","volume":"13","author":"Desgagne","year":"1998","journal-title":"Pharmacoeconomics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1002\/(SICI)1097-0258(20000515)19:9<1141::AID-SIM479>3.0.CO;2-F","article-title":"Bootstrap confidence intervals: When, which, what? A practical guide for medical statisticians","volume":"19","author":"Carpenter","year":"2000","journal-title":"Stat. Med."},{"key":"ref_28","unstructured":"(2022, October 08). National Bureau of Statistics of China, Available online: http:\/\/www.stats.gov.cn\/tjsj\/ndsj\/2021\/indexch.htm."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1111\/1756-185X.13363","article-title":"Disease severity and economic burden in Japanese patients with systemic lupus erythematosus: A retrospective, observational study","volume":"21","author":"Tanaka","year":"2018","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1038\/nrrheum.2016.137","article-title":"The global burden of SLE: Prevalence, health disparities and socioeconomic impact","volume":"12","author":"Carter","year":"2016","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1177\/0961203313499086","article-title":"Chinese SLE Treatment and Research group (CSTAR) registry: I. Major clinical characteristics of Chinese patients with systemic lupus erythematosus","volume":"22","author":"Li","year":"2013","journal-title":"Lupus"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/01.md.0000224709.70133.f7","article-title":"Predictors of survival in systemic lupus erythematosus","volume":"85","author":"Kasitanon","year":"2006","journal-title":"Medicine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/art.20085","article-title":"Systemic lupus erythematosus in three ethnic groups. XIV. Poverty, wealth, and their influence on disease activity","volume":"51","author":"Alarcon","year":"2004","journal-title":"Arthritis Rheum."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.md.0000104742.42401.e2","article-title":"The GLADEL multinational Latin American prospective inception cohort of 1214 patients with systemic lupus erythematosus: Ethnic and disease heterogeneity among \u201cHispanics\u201d","volume":"83","year":"2004","journal-title":"Medicine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1136\/annrheumdis-2012-202443","article-title":"Annual direct medical cost of active systemic lupus erythematosus in five European countries","volume":"73","author":"Doria","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1177\/0961203313517407","article-title":"The cost of care of systemic lupus erythematosus (SLE) in the UK: Annual direct costs for adult SLE patients with active autoantibody-positive disease","volume":"23","author":"Khamashta","year":"2014","journal-title":"Lupus"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e000503","DOI":"10.1136\/lupus-2021-000503","article-title":"Disease and economic burden increase with systemic lupus erythematosus severity 1 year before and after diagnosis: A real-world cohort study, United States, 2004\u20132015","volume":"8","author":"Jiang","year":"2021","journal-title":"Lupus Sci. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2478\/rir-2021-0025","article-title":"Long-term outcomes of patients with systemic lupus erythematosus: A Multicenter Cohort Study from CSTAR registry","volume":"2","author":"Wang","year":"2021","journal-title":"Rheumatol. Immunol. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1136\/ard.2005.046367","article-title":"Cost of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus in Germany","volume":"65","author":"Huscher","year":"2006","journal-title":"Ann. Rheum. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1002\/art.24063","article-title":"Health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus","volume":"59","author":"Panopalis","year":"2008","journal-title":"Arthritis Rheum."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.2147\/PPA.S165101","article-title":"Medication adherence and persistence in patients with autoimmune rheumatic diseases: A narrative review","volume":"12","author":"Anghel","year":"2018","journal-title":"Patient Prefer. Adherence"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1007\/s00296-014-3182-0","article-title":"Determinants of medication non-adherence in Egyptian patients with systemic lupus erythematosus: Sharkia Governorate","volume":"35","year":"2015","journal-title":"Rheumatol. Int."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/4\/3522\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:38:33Z","timestamp":1760121513000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/4\/3522"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,16]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20043522"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20043522","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,16]]}}}