Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Leuven Belgium; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Lancet. 2023 Jun 3;401(10391):1878-1890. doi: 10.1016/S0140-6736(23)00457-9. Epub 2023 May 5.
A rise in the incidence of some autoimmune disorders has been described. However, contemporary estimates of the overall incidence of autoimmune diseases and trends over time are scarce and inconsistent. We aimed to investigate the incidence and prevalence of 19 of the most common autoimmune diseases in the UK, assess trends over time, and by sex, age, socioeconomic status, season, and region, and we examine rates of co-occurrence among autoimmune diseases.
In this UK population-based study, we used linked primary and secondary electronic health records from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex and ethnicity. Eligible participants were men and women (no age restriction) with acceptable records, approved for Hospital Episodes Statistics and Office of National Statistics linkage, and registered with their general practice for at least 12 months during the study period. We calculated age and sex standardised incidence and prevalence of 19 autoimmune disorders from 2000 to 2019 and used negative binomial regression models to investigate temporal trends and variation by age, sex, socioeconomic status, season of onset, and geographical region in England. To characterise co-occurrence of autoimmune diseases, we calculated incidence rate ratios (IRRs), comparing incidence rates of comorbid autoimmune disease among individuals with a first (index) autoimmune disease with incidence rates in the general population, using negative binomial regression models, adjusted for age and sex.
Among the 22 009 375 individuals included in the study, 978 872 had a new diagnosis of at least one autoimmune disease between Jan 1, 2000, and June 30, 2019 (mean age 54·0 years [SD 21·4]). 625 879 (63·9%) of these diagnosed individuals were female and 352 993 (36·1%) were male. Over the study period, age and sex standardised incidence rates of any autoimmune diseases increased (IRR 2017-19 vs 2000-02 1·04 [95% CI 1·00-1·09]). The largest increases were seen in coeliac disease (2·19 [2·05-2·35]), Sjogren's syndrome (2·09 [1·84-2·37]), and Graves' disease (2·07 [1·92-2·22]); pernicious anaemia (0·79 [0·72-0·86]) and Hashimoto's thyroiditis (0·81 [0·75-0·86]) significantly decreased in incidence. Together, the 19 autoimmune disorders examined affected 10·2% of the population over the study period (1 912 200 [13·1%] women and 668 264 [7·4%] men). A socioeconomic gradient was evident across several diseases, including pernicious anaemia (most vs least deprived area IRR 1·72 [1·64-1·81]), rheumatoid arthritis (1·52 [1·45-1·59]), Graves' disease (1·36 [1·30-1·43]), and systemic lupus erythematosus (1·35 [1·25-1·46]). Seasonal variations were observed for childhood-onset type 1 diabetes (more commonly diagnosed in winter) and vitiligo (more commonly diagnosed in summer), and regional variations were observed for a range of conditions. Autoimmune disorders were commonly associated with each other, particularly Sjögren's syndrome, systemic lupus erythematosus, and systemic sclerosis. Individuals with childhood-onset type 1 diabetes also had significantly higher rates of Addison's disease (IRR 26·5 [95% CI 17·3-40·7]), coeliac disease (28·4 [25·2-32·0]), and thyroid disease (Hashimoto's thyroiditis 13·3 [11·8-14·9] and Graves' disease 6·7 [5·1-8·5]), and multiple sclerosis had a particularly low rate of co-occurrence with other autoimmune diseases.
Autoimmune diseases affect approximately one in ten individuals, and their burden continues to increase over time at varying rates across individual diseases. The socioeconomic, seasonal, and regional disparities observed among several autoimmune disorders in our study suggest environmental factors in disease pathogenesis. The inter-relations between autoimmune diseases are commensurate with shared pathogenetic mechanisms or predisposing factors, particularly among connective tissue diseases and among endocrine diseases.
Research Foundation Flanders.
一些自身免疫性疾病的发病率有所上升。然而，目前关于自身免疫性疾病的总体发病率和随时间变化的趋势的估计数据很少且不一致。我们旨在调查英国最常见的 19 种自身免疫性疾病的发病率和患病率，评估随时间推移的趋势，以及按性别、年龄、社会经济地位、季节和地区进行评估，并研究自身免疫性疾病之间的共同发病情况。
在这项英国基于人群的研究中，我们使用了来自临床实践研究数据链（CPRD）的主要和次要电子健康记录，CPRD 是在年龄、性别和种族方面代表英国人口的队列。合格的参与者为男性和女性（无年龄限制），记录良好，经批准与医院发病统计数据和国家统计局链接，并在研究期间至少有 12 个月在其常规医疗实践中登记。我们从 2000 年至 2019 年计算了 19 种自身免疫性疾病的年龄和性别标准化发病率和患病率，并使用负二项式回归模型调查了年龄、性别、社会经济地位、发病季节和英格兰地区在时间上的趋势和差异。为了描述自身免疫性疾病的共同发病情况，我们使用负二项式回归模型，在调整了年龄和性别后，比较了首次（索引）自身免疫性疾病患者的合并自身免疫性疾病的发病率与普通人群的发病率，计算了发病率比值比（IRR）。
在研究中，22009375 名参与者中有 978872 人在 2000 年 1 月 1 日至 2019 年 6 月 30 日期间被诊断患有至少一种自身免疫性疾病（平均年龄 54.0 岁[标准差 21.4]）。这些诊断患者中有 625879 名（63.9%）为女性，352993 名（36.1%）为男性。在研究期间，任何自身免疫性疾病的年龄和性别标准化发病率均增加（2017-19 年与 2000-02 年相比，IRR 为 1.04[95%CI 1.00-1.09]）。观察到最大的增长是在乳糜泻（2.19[2.05-2.35]）、干燥综合征（2.09[1.84-2.37]）和格雷夫斯病（2.07[1.92-2.22]）；恶性贫血（0.79[0.72-0.86]）和桥本甲状腺炎（0.81[0.75-0.86]）的发病率显著下降。在研究期间，共 19 种自身免疫性疾病影响了研究人群的 10.2%（1912200 名女性[13.1%]和 668264 名男性[7.4%]）。在几种疾病中都存在社会经济梯度，包括恶性贫血（最贫困地区与最富裕地区相比，IRR 为 1.72[1.64-1.81]）、类风湿关节炎（1.52[1.45-1.59]）、格雷夫斯病（1.36[1.30-1.43]）和系统性红斑狼疮（1.35[1.25-1.46]）。观察到儿童期发病的 1 型糖尿病（冬季更常见）和白癜风（夏季更常见）有季节性变化，各种疾病的地区变化也有观察到。自身免疫性疾病通常彼此相关，特别是干燥综合征、系统性红斑狼疮和系统性硬化症。儿童期发病的 1 型糖尿病患者也有更高的发病率患有 Addison 病（IRR 26.5[95%CI 17.3-40.7]）、乳糜泻（28.4[25.2-32.0]）和甲状腺疾病（桥本甲状腺炎 13.3[11.8-14.9]和格雷夫斯病 6.7[5.1-8.5]），多发性硬化症与其他自身免疫性疾病的共同发病情况特别低。
大约十分之一的人患有自身免疫性疾病，其负担随着时间的推移以不同的速度持续增加，在不同的疾病中存在差异。我们研究中观察到几种自身免疫性疾病之间的社会经济、季节性和地区差异表明疾病发病机制中存在环境因素。自身免疫性疾病之间的相互关系与共同的发病机制或易患因素相符，尤其是在结缔组织疾病和内分泌疾病之间。
研究基金会佛兰德。
