Understanding the epidemiological trends and patterns of autoimmune diseases is crucial for improving diagnostic strategies, optimizing healthcare resources, and developing targeted interventions.
In this article, we present the findings of a comprehensive population-based study that examined the incidence rates, demographic characteristics, socioeconomic gradients, and co-occurrence patterns of autoimmune diseases.
Methods: The study population consisted of 22,009,375 individuals, of whom 978,872 were newly diagnosed with at least one autoimmune disease between January 1, 2000, and June 30, 2019. The mean age at diagnosis was 54.0 years, with a standard deviation of 21.4. Among the diagnosed individuals, 63.9% were female, and 36.1% were male.
Results: The study found a significant increase in the age and sex standardized incidence rates of autoimmune diseases over the study period (IRR 2017-19 vs 2000-02 1.04 [95% CI 1.00-1.09]).
The most notable increases were observed in:
- coeliac disease (2.19 [2.05-2.35]),
- Sjogren’s syndrome (2.09 [1.84-2.37])
- Graves’ disease (2.07 [1.92-2.22]).
Conversely,
- pernicious anaemia (0.79 [0.72-0.86])
- Hashimoto’s thyroiditis (0.81 [0.75-0.86])
showed a significant decrease in incidence.
Across the study period, autoimmune disorders affected 10.2% of the population (13.1% women and 7.4% men). A socioeconomic gradient was observed for several diseases, including pernicious anaemia, rheumatoid arthritis, Graves’ disease, and systemic lupus erythematosus. There were also seasonal and regional variations in disease incidence.
Childhood-onset type 1 diabetes was more commonly diagnosed in winter, while vitiligo showed a higher incidence in summer. Additionally, certain autoimmune diseases exhibited regional variations.
The study revealed a high degree of co-occurrence among different autoimmune diseases. Sjogren’s syndrome, systemic lupus erythematosus, and systemic sclerosis showed a particularly strong association. Individuals with childhood-onset type 1 diabetes had significantly higher rates of Addison’s disease, coeliac disease, and thyroid diseases (Hashimoto’s thyroiditis and Graves’ disease). On the other hand, multiple sclerosis had a lower rate of co-occurrence with other autoimmune diseases.
Discussion and Conclusion: This population-based study provides valuable insights into the trends, demographic characteristics, socioeconomic gradients, and co-occurrence patterns of autoimmune diseases. The observed increase in incidence rates of certain autoimmune diseases highlights the need for further research into the underlying factors contributing to this rise.
The findings of this study have implications for healthcare planning, resource allocation, and patient management. The identification of seasonal and regional variations in disease incidence emphasizes the importance of tailored preventive strategies and targeted healthcare interventions.
Further research is warranted to explore the reasons behind the observed changes in incidence rates, such as shifts in environmental exposures, changes in diagnostic criteria, or alterations in lifestyle factors. Understanding the underlying causes of these trends can aid in the development of preventive strategies and early interventions.
The socioeconomic gradient observed in certain autoimmune diseases highlights the need for equitable access to healthcare and targeted interventions for vulnerable populations. Efforts should be made to reduce disparities and improve healthcare outcomes for individuals from socioeconomically disadvantaged backgrounds.
The co-occurrence of specific autoimmune diseases suggests shared genetic susceptibility and shared pathogenic mechanisms. These findings can inform future research into the common pathways and potential therapeutic targets for multiple autoimmune disorders. Understanding the interplay between different autoimmune diseases can provide valuable insights for disease management and treatment strategies.
While this study provides important population-based data on autoimmune diseases, it is crucial to acknowledge certain limitations. The study relied on diagnosis codes and administrative data, which may introduce misclassification and underestimation of disease incidence. Additionally, the study population was limited to a specific time frame, and the findings may not capture the most recent trends in autoimmune diseases.
The observed increase in incidence rates, socioeconomic gradients, and co-occurrence patterns highlight the complex nature of these disorders and the need for further research. By advancing our understanding of autoimmune diseases, we can strive for improved diagnosis, treatment, and management strategies to enhance the quality of life for individuals affected by these conditions.
Some common autoimmune disorders
- Rheumatoid Arthritis (RA): RA is a chronic inflammatory disorder that primarily affects the joints, causing pain, swelling, and stiffness. It can also affect other organs in the body.
- Systemic Lupus Erythematosus (SLE): SLE is a systemic autoimmune disease that can affect multiple organs, including the skin, joints, kidneys, heart, and lungs. It is characterized by a wide range of symptoms, including fatigue, joint pain, skin rashes, and organ inflammation.
- Multiple Sclerosis (MS): MS is a chronic autoimmune disease that affects the central nervous system. It occurs when the immune system mistakenly attacks the protective covering of nerve fibers, leading to communication problems between the brain and the rest of the body.
- Type 1 Diabetes: Type 1 diabetes is an autoimmune disease that occurs when the immune system destroys the insulin-producing cells in the pancreas. This results in high blood sugar levels and requires lifelong insulin treatment.
- Hashimoto’s Thyroiditis: Hashimoto’s thyroiditis is an autoimmune disorder that targets the thyroid gland, leading to inflammation and decreased thyroid hormone production. Symptoms may include fatigue, weight gain, and depression.
- Celiac Disease: Celiac disease is an autoimmune disorder triggered by the consumption of gluten. It damages the lining of the small intestine and interferes with nutrient absorption. Symptoms may include abdominal pain, diarrhea, and weight loss.
- Psoriasis: Psoriasis is a chronic autoimmune skin disorder characterized by the rapid overproduction of skin cells, leading to the development of thick, scaly patches on the skin. It can also affect the nails and joints.
- Sjögren’s Syndrome: Sjögren’s syndrome primarily affects the moisture-producing glands, resulting in dry eyes and dry mouth. It can also cause fatigue and joint pain.
- Systemic Sclerosis (Scleroderma): Systemic sclerosis is characterized by abnormal collagen production, leading to the hardening and thickening of the skin and connective tissues. It can affect the skin, blood vessels, digestive system, and other organs.
- Myasthenia Gravis: Myasthenia gravis is a neuromuscular disorder that causes muscle weakness and fatigue. It occurs when the immune system attacks the connections between nerves and muscles, impairing proper muscle function.
- Vasculitis: Vasculitis refers to a group of disorders characterized by inflammation of blood vessels. It can affect small, medium, or large vessels, leading to various symptoms depending on the affected organs.
- Ankylosing Spondylitis: Ankylosing spondylitis primarily affects the spine, causing inflammation, pain, and stiffness. It can also affect other joints and organs.
- Addison’s Disease: Addison’s disease occurs when the immune system attacks the adrenal glands, leading to insufficient production of hormones such as cortisol and aldosterone. Symptoms may include fatigue, weight loss, and low blood pressure.
- Pemphigus: Pemphigus is a group of autoimmune disorders that cause blistering of the skin and mucous membranes. It occurs due to autoantibodies targeting proteins that hold skin cells together.
- Primary Biliary Cholangitis: Primary biliary cholangitis is characterized by the destruction of small bile ducts within the liver, leading to impaired bile flow. It can result in liver damage and dysfunction.
- Pernicious Anemia: Pernicious anemia occurs when the body is unable to absorb enough vitamin B12, leading to a deficiency. It is characterized by fatigue, weakness, and neurological symptoms.
- Antiphospholipid Syndrome: Antiphospholipid syndrome is an autoimmune disorder that causes abnormal blood clotting. It can lead to complications such as deep vein thrombosis, stroke, and pregnancy-related complications.
- Goodpasture’s Syndrome: Goodpasture’s syndrome is a rare autoimmune disorder that primarily affects the lungs and kidneys. It is characterized by the development of antibodies that attack the lungs’ alveoli and the kidneys’ glomeruli.
- Autoimmune Hepatitis: Autoimmune hepatitis is inflammation of the liver caused by an autoimmune reaction. It can lead to liver damage and, if left untreated, progress to cirrhosis and liver failure.
- Polymyalgia Rheumatica: Polymyalgia rheumatica is an inflammatory disorder that primarily affects the muscles and joints, causing pain, stiffness, and limited mobility, especially in the shoulders and hips.
- Behçet’s Disease: Behçet’s disease is a chronic autoimmune condition characterized by inflammation of blood vessels throughout the body. It can cause recurrent mouth and genital ulcers, eye inflammation, and skin lesions.
- Dermatomyositis: Dermatomyositis is an inflammatory disorder that primarily affects the skin and muscles. It presents with skin rashes and muscle weakness and can be associated with underlying malignancies.
- Wegener’s Granulomatosis (Granulomatosis with Polyangiitis): Wegener’s granulomatosis is a rare autoimmune disorder that primarily affects the blood vessels of the respiratory system and kidneys. It causes inflammation, tissue damage, and the formation of granulomas.
- Myasthenic Syndrome (Lambert-Eaton Syndrome): Myasthenic syndrome is an autoimmune disorder that affects the neuromuscular junction, leading to muscle weakness. It is often associated with underlying malignancies.
- Bullous Pemphigoid: Bullous pemphigoid is a chronic autoimmune disorder that causes large, fluid-filled blisters on the skin. It occurs due to autoantibodies attacking the skin’s basement membrane.
- IgA Nephropathy (Berger’s Disease): IgA nephropathy is a kidney disease characterized by the accumulation of immunoglobulin A (IgA) in the kidneys, leading to inflammation and impaired kidney function.
- Autoimmune Pancreatitis: Autoimmune pancreatitis is a rare form of chronic pancreatitis that occurs when the immune system mistakenly attacks the pancreas, causing inflammation and damage.
- Pemphigoid Gestationis: Pemphigoid gestationis is a rare autoimmune blistering disorder that typically occurs during pregnancy. It causes itchy, blistering rashes on the abdomen and other parts of the body.
- Eosinophilic Esophagitis: Eosinophilic esophagitis is an allergic inflammatory condition in which eosinophils (a type of white blood cell) accumulate in the esophagus, leading to swallowing difficulties and food impaction.
- Antisynthetase Syndrome: Antisynthetase syndrome is a group of autoimmune disorders characterized by the presence of specific autoantibodies targeting aminoacyl-tRNA synthetases. It can cause muscle inflammation, interstitial lung disease, and arthritis.
- Autoimmune Inner Ear Disease: Autoimmune inner ear disease is a condition in which the immune system attacks the inner ear, leading to sensorineural hearing loss, dizziness, and balance problems.
- Stiff Person Syndrome: Stiff person syndrome is a rare neurological disorder characterized by muscle stiffness and spasms. It is thought to be caused by an autoimmune reaction against specific proteins involved in muscle function.
- Autoimmune Hemolytic Anemia: Autoimmune hemolytic anemia is a condition in which the immune system destroys red blood cells, leading to anemia. It can cause fatigue, jaundice, and shortness of breath.
- Primary Sclerosing Cholangitis: Primary sclerosing cholangitis is a chronic liver disease characterized by inflammation and scarring of the bile ducts, leading to liver dysfunction and the risk of developing liver cirrhosis.
- Autoimmune Encephalitis: Autoimmune encephalitis is a condition in which the immune system attacks the brain, resulting in inflammation and neurological symptoms such as seizures, memory problems, and personality changes.
reference link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00457-9/fulltext
