This study aimed to identify a high‐need, high‐cost (HNHC) group among hospitalized lupus patients and compare clinical and social factors of the HNHC group with other lupus patients.All hospitalizations for lupus to a tertiary care center over three years were recorded. The number of admissions, 30‐day readmissions, length of stay (LOS), and admissions cost were compared for high‐risk patients with all other hospitalized lupus patients (OHLP) during this period. We additionally differentiated social factors‐ age, race/ethnicity, poverty, and medication adherence between the two groups.

A total of 202 patients with lupus accounted for 467 hospitalizations over the study period. The total cost of admissions was $13,192,346. Forty‐four patients had significantly higher admissions, 30‐day readmissions, and LOS. Furthermore, this group’s cost was 6‐fold for OHLP, confirming the presence of an HNHC cohort. The HNHC group had significantly higher dsDNA, SDI, and CMI compared with the OHLP. Infections were the most common cause of admission for both groups. The HNHC group were more likely to be African American, younger, diagnosed with lupus at an earlier age, have lower medication adherence, and were significantly more likely to live in poverty areas.

In conclusion, the HNHC group has both social and clinical factors significantly different from other lupus patients.