Elsevier

Autoimmunity Reviews

Volume 2, Issue 3, May 2003, Pages 119-125
Autoimmunity Reviews

The epidemiology of autoimmune diseases

https://doi.org/10.1016/S1568-9972(03)00006-5Get rights and content

Abstract

Autoimmune diseases are among the leading causes of death among young and middle-aged women in the United States. Incidence rates vary among the autoimmune diseases, with estimates ranging from less than one newly-diagnosed case of systemic sclerosis to more than 20 cases of adult-onset rheumatoid arthritis per 100 000 person-years. Prevalence rates range from less than 5 per 100 000 (e.g. chronic active hepatitis, uveitis) to more than 500 per 100 000 (Grave disease, rheumatoid arthritis, thyroiditis). At least 85% of thyroiditis, systemic sclerosis, systemic lupus erythematosus, and Sjögren disease patients are female. Although most diseases can occur at any age, some diseases primarily occur in childhood and adolescence (e.g. type 1 diabetes), in the mid-adult years (e.g. myasthenia gravis, multiple sclerosis), or among older adults (e.g. rheumatoid arthritis, primary systemic vasculitis). Ethnic and geographic differences in incidence of specific autoimmune diseases have been documented, but specific groups may be at higher risk for some diseases and lower risk for other diseases. The incidence of type 1 diabetes increased but the rates of rheumatoid arthritis declined over the past 40 years. Thus although there are commonalities, there are also important demographic differences between diseases. Disease-specific research, as well as studies that focus on potentially related diseases, needs to be conducted.

Introduction

Epidemiology can be described as the study of the distribution, and the determinants of the distribution, of disease within a population. Autoimmune diseases as a group represent a diverse collection of diseases in terms of their demographic profile and primary clinical manifestations [1]. The commonality between them, however, is the damage to tissues and organs that arises from the response to self-antigens. Research (laboratory-based and epidemiologic) generally focuses on an individual disease although there is evidence of some common genetic and environmental risk factors across diseases [2], [3].

Autoimmune diseases are generally thought of as being relatively rare, but their effects on mortality and morbidity are quite high. Autoimmune diseases are among the leading causes of death among young and middle-aged women (ages <65 years) in the United States [4]. The chronic nature of many of these diseases results in a significant impact in terms of medical care utilization, direct and indirect economic costs, and quality of life.

Section snippets

Incidence and prevalence of autoimmune diseases

Jacobson et al. recently summarized available studies pertaining to the incidence and prevalence of specific autoimmune diseases [1]. Data on at least one of these rates were available for 19 of the 24 selected diseases. Table 1 summarizes this analysis, with additional information from studies of Addison disease [5], adult-onset type 1 diabetes [6], [7], juvenile rheumatoid arthritis [8], [9], systemic sclerosis (scleroderma) [10], Sjögren disease [11] and Wegener granulomatosis and systemic

Summary

There are several epidemiologic questions pertaining to autoimmune diseases and autoantibodies that require additional research. Basic descriptive information (incidence, prevalence, age, sex, ethnic or racial distributions, temporal changes in incidence) is lacking for many diseases. Although there may be commonalities between some autoimmune diseases (e.g. the increased risk experience by women), autoimmune diseases as a group do not follow consistent demographic patterns. Disease-specific

Acknowledgements

This research was supported by the Intramural Research Program of the National Institute of Environmental Health Sciences and the National Center for Minority Health and Health Disparities of the National Institutes of Health.

References (40)

  • D.L. Jacobson et al.

    Epidemiology and estimated population burden of selected autoimmune diseases in the United States

    Clin Immunol Immunopathol

    (1997)
  • G.S. Cooper et al.

    Occupational exposures and autoimmune diseases

    Int Immunopharmacol

    (2002)
  • S.R. Pillemer et al.

    Incidence of physician-diagnosed primary Sjögren syndrome in residents of Olmsted County, Minnesota

    Mayo Clin Proc

    (2001)
  • K.G. Becker et al.

    Clustering of non-major histocompatibility complex susceptibility candidate loci in human autoimmune diseases

    Proc Natl Acad Sci USA

    (1998)
  • S.J. Walsh et al.

    Autoimmune diseases: a leading cause of death among young and middle-aged women in the United States

    Am J Public Health

    (2000)
  • K. Løväs et al.

    High prevalence and increasing incidence of Addison's disease in western Norway

    Clin Endocrinol (Oxf)

    (2002)
  • K.O. Kyvik et al.

    Incidence of type 1 diabetes in young adults across Europe—an EU funded multicentre study (IDA)

    Diabetologia

    (2001)
  • K. Ostrauskas et al.

    Incidence of type 1 diabetes mellitus over eight consecutive years among 15–39 year aged Lithuanian population

    Diabetologia

    (2001)
  • L.S. Peterson et al.

    Juvenile rheumatoid arthritis in Rochester, Minnesota 1960–1993. Is the epidemiology changing?

    Arthritis Rheum

    (1996)
  • N. Moe et al.

    Epidemiology of juvenile chronic arthritis in northern Norway: a ten-year retrospective study

    Clin Exp Rheumatol

    (1998)
  • V.D. Steen et al.

    Incidence of systemic sclerosis in Allegheny County, Pennsylvania. A twenty-year study of hospital-diagnosed cases, 1963–1982

    Arthritis Rheum

    (1997)
  • M.F. Cotch et al.

    The epidemiology of Wegener's granulomatosis. Estimates of the five-year period prevalence, annual mortality, and geographic disease distribution from population-based data sources

    Arthritis Rheum

    (1996)
  • R.A. Watts et al.

    Epidemiology of systemic vasculitis: a ten-year study in the United Kingdom

    Arthritis Rheum

    (2000)
  • J.J. Rangasami et al.

    Rising incidence of type 1 diabetes in Scottish children, 1984–1993

    Arch Dis Child

    (1997)
  • J.N. Kostraba et al.

    Incidence of insulin-dependent diabetes mellitus in Colorado

    Epidemiology

    (1992)
  • K.M. Uramoto et al.

    Trends in the incidence and mortality of systemic lupus erythematosus, 1950–1990

    Arthritis Rheum

    (1999)
  • D.J. McCarty et al.

    Incidence of systemic lupus erythematosus. Race and gender differences

    Arthritis Rheum

    (1995)
  • N.D. Hopkinson et al.

    The prevalence and incidence of systemic lupus erythematosus in Nottingham, UK, 1989–1990

    Br J Rheumatol

    (1993)
  • A.E. Johnson et al.

    The prevalence and incidence of systemic lupus erythematosus in Birmingham, England. Relationship to ethnicity and country of birth

    Arthritis Rheum

    (1995)
  • T.J. Laing et al.

    Racial differences in scleroderma among women in Michigan

    Arthritis Rheum

    (1997)
  • Cited by (663)

    View all citing articles on Scopus
    View full text