Akmatov Manas K, Kohring Claudia, Pessler Frank, Holstiege Jakob
Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Salzufer 8, Berlin, 10587, Germany.
TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany.
Res Health Serv Reg. 2025 Mar 26;4(1):3. doi: 10.1007/s43999-025-00061-5.
Research on the epidemiology of autoimmune diseases is impeded due to the rarity of most autoimmune diseases. We aimed to assess the prevalence of diagnosed autoimmune diseases in Germany and examine their sex-specific and regional differences.
A cross-sectional study using the nationwide ambulatory claims data of females and males of any age with statutory health insurance from 2022 was designed (N = 73,241,305). Autoimmune diseases were identified by diagnostic codes of the International Classification of Diseases and Related Health Problems, 10th Revision, German Modification (ICD-10-GM). Regional differences were examined at the level of urban and rural districts (N = 401). To control for demographic differences across districts we applied the direct standardization method to calculate sex- and age-standardized prevalences with the German population in 2022 used as a standard population. Furthermore, we calculated prevalence ratios (PR) and 99% confidence intervals (99% CI) to examine sex differences.
Of 73,241,305 insurees (median age, 45; interquartile range, 26-63 years), 6,307,120 had at least one (any) autoimmune disease in 2022, corresponding to a crude prevalence of 8.61% (99% CI: 8.60-8.62%). Of all individuals with autoimmune diseases, 67% were females. The prevalence of single autoimmune diseases varied between 0.008% (pemphigus) and 2.3% (autoimmune thyroiditis). Other autoimmune diseases with a high prevalence were psoriasis (1.9%), rheumatoid arthritis (1.4%), and type 1 diabetes (0.75%). The prevalence was higher in females than males for 25 of the 31 autoimmune diseases with the highest PR observed for autoimmune thyroiditis (PR 5.92; 99% CI: 5.88-5.95), primary biliary cirrhosis (5.60; 5.36-5.84) and systemic lupus erythematosus (5.15; 4.97-5.36). Males were more likely to be diagnosed than females with type 1 diabetes (1.37; 1.36-1.39), ankylosing spondylitis (1.40; 1.39-1.43) and Guillain-Barré syndrome (1.31; 1.27-1.37). The only autoimmune disease without sex difference was myasthenia gravis (1.00; 0.97-1.03). At district level the age- and sex-standardized prevalence of at least one (any) autoimmune disease differed by a factor of nearly 2 between 5.91% and 11.62%. In general, the prevalence was higher in East (former GDR) than West (former FRG) Germany.
Although most autoimmune diseases were rare, when considered as a whole, autoimmune diseases turned out to be more common than previously assumed, with one out of 12 individuals affected in Germany.
由于大多数自身免疫性疾病较为罕见，自身免疫性疾病的流行病学研究受到阻碍。我们旨在评估德国确诊的自身免疫性疾病的患病率，并研究其性别和地区差异。
设计了一项横断面研究，使用2022年全国范围内任何年龄参加法定医疗保险的女性和男性的门诊索赔数据（N = 73,241,305）。通过《疾病和相关健康问题国际统计分类》第10次修订版德国修订本（ICD-10-GM）的诊断代码识别自身免疫性疾病。在城乡地区（N = 401）层面研究地区差异。为了控制各地区之间的人口统计学差异，我们应用直接标准化方法，以2022年德国人口作为标准人群来计算性别和年龄标准化患病率。此外，我们计算患病率比（PR）和99%置信区间（99%CI）以研究性别差异。
在73,241,305名被保险人中（年龄中位数为45岁；四分位间距为26 - 63岁），2022年有6,307,120人至少患有一种（任何）自身免疫性疾病，粗患病率为8.61%（99%CI：8.60 - 8.62%）。在所有患有自身免疫性疾病的个体中，67%为女性。单一自身免疫性疾病的患病率在0.008%（天疱疮）至2.3%（自身免疫性甲状腺炎）之间。其他患病率较高的自身免疫性疾病包括银屑病（1.9%）、类风湿性关节炎（1.4%）和1型糖尿病（0.75%）。在31种自身免疫性疾病中，有25种疾病女性患病率高于男性，自身免疫性甲状腺炎的PR最高（PR 5.92；99%CI：5.88 - 5.95），原发性胆汁性肝硬化（5.60；5.36 - 5.84）和系统性红斑狼疮（5.15；4.97 - 5.36）。1型糖尿病（1.37；1.36 - 1.39）、强直性脊柱炎（1.40；1.39 - 1.43）和吉兰 - 巴雷综合征（1.31；1.27 - 1.37）男性被诊断的可能性高于女性。唯一无性别差异的自身免疫性疾病是重症肌无力（1.00；0.97 - 1.03）。在地区层面，至少患有一种（任何）自身免疫性疾病的年龄和性别标准化患病率在5.91%至11.62%之间相差近2倍。总体而言，德国东部（前东德）的患病率高于西部（前西德）。
尽管大多数自身免疫性疾病较为罕见，但总体来看，自身免疫性疾病比之前认为的更为常见，德国每12人中就有1人受影响。
