Systemic lupus erythematosus is a disease distributed worldwide that occurs in both genders and across racial/ethnic and age groups; however, higher rates are observed in adults, women, and nonCaucasians. Genetic, environmental, sociodemographic, and methodological issues are responsible for these differences and for the variable course and outcome of the disease. NonCaucasians may have more severe disease with a higher risk for early mortality and damage accrual. Males also may have a more severe disease; however, a negative impact of male gender on lupus outcomes has not been firmly established. Childhood onset is associated with a more severe disease and diminished survival compared to healthy children; however, it is not associated with higher damage. Finally, late-onset lupus is associated with a mild disease but with higher damage accrual and a diminished survival.