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The World Incidence and Prevalence of Autoimmune Diseases is Increasing

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Epidemiological data provide evidence of a steady rise in autoimmune disease throughout Westernized societies over the last decades. Multiple publications exist, describing past or actual incidences/prevalence of individual autoimmune diseases, however, long term studies on selected populations are scarce. Aims: to calculate the % increases per year of autoimmune diseases frequencies worldwide, analyze the differential increases per country and disease, and identify geoepidemiological trends. Methods: A systematic review was performed to identify incidence and prevalence of autoimmune diseases. 30 Studies from the last 30 years were identified using Medline, Google, and Cochrane Library databases. Only long-term regional or national follow-ups are reported. Results: The means ± s.d. of the net % increased /year incidence and prevalence of autoimmune diseases worldwide were 19.1±43.1 and 12.5±7.9, respectively. Rheumatic, endocrinological, gastrointestinal and neurological autoimmune diseases revealed the following annual % increases per year: 7.1, 6.3, 6.2, and 3.7, respectively. In all of these, differences between old vs new frequencies were highly significant (p < 0.0001). Comparing various autoimmune diseases, celiac disease increased the most and the highest increase in incidence, comparing old to new surveys is allocated to myasthenia gravis. Despite considerable variations between the countries, celiac, type 1 diabetes and myasthenia gravis frequencies increased the most in Canada, Israel and Denmark, respectively. Frequencies of the autoimmune diseases increased significantly in the West and North when compared to East and South, respectively. Conclusions: Despite multiple reports on autoimmune diseases frequencies, long-term longitudinal follow-ups are scarce. Incidences and prevalences have increased significantly over the last 30 years. Rheumatic, endocrinological and gastrointestinal autoimmune diseases in Israel, Netherlands, USA and Sweden increased the most. These observations point to a stronger influence of environmental factors as opposed to genetic factors on autoimmune disease development.
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International Journal of Celiac Disease, 2015, Vol. 3, No. 4, 151-155
Available online at http://pubs.sciepub.com/ijcd/3/4/8
© Science and Education Publishing
DOI:10.12691/ijcd-3-4-8
The World Incidence and Prevalence of Autoimmune
Diseases is Increasing
Aaron Lerner1,*, Patricia Jeremias2, Torsten Matthias2
1B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
2AESKU.KIPP Institute, Wendelsheim, Germany
*Corresponding author: aaronlerner1948@gmail.com
Received September 27, 2015; Revised October 29, 2015; Accepted November 11, 2015
Abstract Epidemiological data provide evidence of a steady rise in autoimmune disease throughout Westernized
societies over the last decades. Multiple publications exist, describing past or actual incidences/prevalence of
individual autoimmune diseases, however, long term studies on selected populations are scarce. Aims: to calculate
the % increases per year of autoimmune diseases frequencies worldwide, analyze the differential increases per
country and disease, and identify geoepidemiological trends. Methods: A systematic review was performed to
identify incidence and prevalence of autoimmune diseases. 30 Studies from the last 30 years were identified using
Medline, Google, and Cochrane Library databases. Only long-term regional or national follow-ups are reported.
Results: The means ± s.d. of the net % increased /year incidence and prevalence of autoimmune diseases worldwide
were 19.1±43.1 and 12.5±7.9, respectively. Rheumatic, endocrinological, gastrointestinal and neurological
autoimmune diseases revealed the following annual % increases per year: 7.1, 6.3, 6.2, and 3.7, respectively. In all of
these, differences between old vs new frequencies were highly significant (p< 0.0001). Comparing various
autoimmune diseases, celiac disease increased the most and the highest increase in incidence, comparing old to new
surveys is allocated to myasthenia gravis. Despite considerable variations between the countries, celiac, type 1
diabetes and myasthenia gravis frequencies increased the most in Canada, Israel and Denmark, respectively.
Frequencies of the autoimmune diseases increased significantly in the West and North when compared to East and
South, respectively. Conclusions: Despite multiple reports on autoimmune diseases frequencies, long-term
longitudinal follow-ups are scarce. Incidences and prevalences have increased significantly over the last 30 years.
Rheumatic, endocrinological and gastrointestinal autoimmune diseases in Israel, Netherlands, USA and Sweden
increased the most. These observations point to a stronger influence of environmental factors as opposed to genetic
factors on autoimmune disease development.
Keywords: autoimmune disease, incidence, prevalence, surge, geoepidemiology
Cite This Article: Aaron Lerner, Patricia Jeremias, and Torsten Matthias, The World Incidence and
Prevalence of Autoimmune Diseases is Increasing.” International Journal of Celiac Disease, vol. 3, no. 4 (2015):
151-155. doi: 10.12691/ijcd-3-4-8.
1. Introduction
Increasing evidence is accumulating for a steady rise in
the frequency of autoimmune diseases (AD), in the last
decades [1]. In fact, the rise in ADs parallels the surge in
allergic and cancer conditions while infections are less
frequent in the Western societies, creating the basis for the
hygiene hypothesis [2]. Multiple sclerosis (MS), type 1
diabetes (IDDM), inflammatory bowel diseases (mainly
Crohn’s disease) (IBD), systemic lupus erythematosus
(SLE), primary biliary cirrhosis, myasthenia gravis (MS),
autoimmune thyroiditis (AT), hepatitis and rheumatic
diseases (RA), bullous pemphigoid, and celiac disease
(CD) are several examples [3,4]. Their relationship to
socioeconomic status, their rapid increase in developed
countries and observations in selected migrant populations,
indicate some form of environmental impact, rather than
long-term genetic influences which are driving these
recent evolutionary processes [1,2,3,4,5]. Among many
others, three major environmental factors, strongly related
to socioeconomical status are suspected to drive these
phenomena: infections, ecology and nutrition. The
purpose of the present review is to calculate the surge per
year of AD frequencies worldwide and analyze the
differential increases of AD per country and disease
identifying geoepidemiological trends. There is a plethora
of publications on the incidences/prevalences of ADs in
medical literature, most of them describe past or actual
frequencies of individual ADs, however, long term
comparative follow-up studies on selected populations, in
individual countries are scarce.
2. Methods
A Medline search was performed using the following
search words: autoimmune disease or syndrome, incidence,
prevalence or frequency, spanning the period 1985-2015.
152 International Journal of Celiac Disease
Special emphasis was given to the identification of
increase/surge or decrease in incidence/prevalence
worldwide. Suitable publications were identified by
periodical scans of PubMed but also Google, and the
Cochrane Library databases, were screened. Original
papers, in the English language, especially those on
epidemiology of autoimmune diseases commonly
encountered, were identified. Foreign language papers
with English abstracts were also identified. Only long-
term regional or national longitudinal follow-ups are
reported. Hospital archived data, specific high-risk groups
or case reports, were excluded. Entities were validated and
used when directly stating at least one of the
abovementioned epidemiological indices. Chi-square test
or Fisher`s exact test were used for categorical data and p-
values less than 0.05 were considered as statistically
significant. Statistical analyses were performed using the
statistics software MedCalc version 15.6.1.
3. Results
30 studies were identified. The means ± s.d. of the
net % increased /year incidence and prevalence of ADs
worldwide were 19.1±43.1 and 12.5±7.9, respectively
(Figure 1). Of interest, grouping the different ADs to
disease categories, the highest net % increase per year was
noted in the rheumatologic (7.1), followed by endocrine
(6.3), gastrointestinal (6.2) and neurological diseases (3.7).
In all of these, differences between old vs new frequencies
were highly significant (p< 0.0001) (Figure 2). The table
inserted in Figure 2 details the diseases and the countries
included in the 4 disease categories.
Figure 1. The net % increase/year of the incidence and prevalence of
autoimmune diseases worldwide
Figure 2. (A) The net %/year increases of diseases’ categories. (B) The table below is detailing the different diseases and countries surveyed
The net increase/year of various diseases in specific
countries and old vs. new surveys of incidence/prevalence
of various autoimmune diseases, are shown in Figure 3A
and 3B, respectively. Figure 3A shows the total net
increase of Old vs. New surveys of incidence/prevalence
of various autoimmune diseases, (mean time interval RA
14.5, AT 13.5, Chron`s 11.5, IBD 11.0, IDDM 17.8,
Celiac 16.8 and MG 27 years, respectively), During the
reported time interval. CD increased the most
(26.3/year %) and the higher increase in incidence,
comparing old to new surveys is allocated to MG (432%)
(Figure 3A and Figure 3B). Geoepidemiologically, the
following countries had high to low % increases /year of
AD frequencies: Israel, Netherlands, USA, Sweden, UK,
Finland, Canada, and Denmark with 12.9, 10.0, 8.8, 8.4,
7.8, 7.6, 7.3 and 6.3 %, respectively. There was no
statistically significant difference between children and
adults in the increase of AD incidence/ prevalence
(p=0.8036). Figure 4 shows, as an example, two frequent
ADs like CD and IDDM and one, less frequent one like
MG surveys in various countries. A considerable variation
is noticed between the countries. CD, IDDM and MG
International Journal of Celiac Disease 153
frequencies increased the most in Canada, Israel and Denmark, respectively.
Figure 3. (A) Old vs. New surveys of incidence/prevalence of various autoimmune diseases. (B) The list of various diseases in specific countries and
the years’ ranges
Figure 4. The net increase %/year of 3 autoimmune diseases in the surveyed countries
154 International Journal of Celiac Disease
The geoepidemiologic trend of the net increase %/year
of the various ADs is described in Figure 5. Frequencies of the ADs increased significantly in the West and North
when compared to East and South, respectively.
Figure 5. The geoepidemiology of the net increase %/year of autoimmune diseases
4. Discussion
Population-based estimates of the incidence/prevalence
of ADs in different countries are crucial for investigating
possible etiologies or influencing environmental factors or
underlining risk factors.
Quantification of the likely healthcare burden and the
planning of future strategies to face the ongoing epidemic
of ADs is of no less importance. More so, the beneficial
aspects of early recognition of ADs are well known.
Multiple AD related complications can be prevented or
treated when the disease is diagnosed early enough. The
increased awareness responsible for the surge in
diagnosed patients, needs to continue together with a
lower threshold for screening high risk populations using
a cheap, non-invasive and reliable antibody biomarker to
prevent delays in diagnosing such a common but
preventable disease [6,7,8].
The net increased incidences/prevalences of ADs in the
Northern and Western countries, compared to the Southern
and Eastern ones follows the global geoepidemiological
trends of autoimmune diseases [9,10]. By reviewing
available literature, it can be deduced that frequency of
ADs have increased significantly over the last 30 years.
The recent outbreak of autoimmune diseases in
industrialized countries has brought into question the
factors contributing to this increased incidence. Given the
constancy of genetics, growing attention has focused on
environmental factors, and in particular, the western
lifestyle [3,4,11]. Indeed, over the last few decades
significant changes in western dietary habits,
environmental surroundings and pollution exposure,
infectious habitat and stress load, have led to a parallel
rise in autoimmune diseases. Thus, ADs occupies an
important place in this environmental mosaic of
autoimmunity, allergy and cancer surges [2].
The present study can serve as a platform for
geoepidemiological inquiries, concerning offending/
defending environmental changes. If CD is taken as an
example, how comes the surge in the disease frequency
was much higher in Canada, Israel and Netherlands,
compared to the low rates in Estonia and New Zealand?
Considering the diseases, what environmental forces
contributed to the higher surge of CD and MG, compared
to IBD and IDDM? Comparing the disease categories,
why are rheumatic disease surges higher than the
neurological ones? Is it the infectious or stress loads? The
intestinal disbiosis allocated to specific diseases? Driving
openers of the intestinal tight-junctions? Or is it the
increased public/professional awareness or the improved
diagnosis? A vast list of questions and so few answers.
The present study has multiple biases and drawbacks.
The follow up surveys were not done by the same team
nor by the same methodology, some of the relevant
studies might have escaped detection, the genetic makeup
and the environment are different in the screened countries,
the environmental forces are dynamic and most probably
changed during the last decades, the actual public and
professional awareness to autoimmunity and the
diagnostic bio-markers have evolved tremendously.
Despite those biases, the present study highlights the
significant surge in AD incidence and prevalence, detailing
the variations in disease entities and the corresponding
countries and substantiate the geoepidemiological trends.
The present literature survey is not aiming to investigate
etiologies or environmental factors affecting autoimmune
induction or progression. It is expected that an improved
knowledge of the worldwide distribution of autoimmune
disorders will help to understand the role of different
genetic factors and different environmental influences
involved in autoimmunogenesis. At a public level the
epidemiological studies are necessary to assess the social
and economic burdens impacting the health systems in the
different countries, and worldwide.
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