Systemic lupus erythematosus (SLE) 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 non-Caucasians. Genetic, environmental, sociodemographic, and methodological issues are responsible for these differences and for the variable course and outcome of the disease. Non-Caucasians 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; however, it is not associated with higher damage or diminished survival. Finally, late-onset lupus is associated with a mild disease but with higher damage accrual and a diminished survival.