Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK

• Published in: The Lancet (British edition) 2023-06, Vol.401 (10391), p.1878-1890
• Main Authors: Conrad, Nathalie, Misra, Shivani, Verbakel, Jan Y, Verbeke, Geert, Molenberghs, Geert, Taylor, Peter N, Mason, Justin, Sattar, Naveed, McMurray, John J V, McInnes, Iain B, Khunti, Kamlesh, Cambridge, Geraldine
• Format: Article
• Language: English
• Subjects: Addison's disease; Age; Anemia; Anemia, Pernicious - complications; Autoimmune diseases; Autoimmune Diseases - complications; Autoimmune Diseases - epidemiology; Celiac disease; Celiac Disease - complications; Celiac Disease - epidemiology; Child; Children; Chronic conditions; Clinical medicine; Cohort analysis; Cohort Studies; Connective tissue diseases; Connective tissues; Diabetes; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - complications; Disease prevention; Electronic health records; Electronic medical records; England; Environmental factors; Ethnicity; Female; Graves disease; Graves Disease - complications; Hashimoto's thyroiditis; Humans; Incidence; Lupus; Lupus Erythematosus, Systemic; Male; Mathematical analysis; Men; Middle Aged; Multiple sclerosis; Pathogenesis; Pernicious anemia; Population studies; Population-based studies; Prevalence; Primary care; Psoriasis; Public health; Regression analysis; Regression models; Rheumatoid arthritis; Risk factors; Seasonal variations; Sex; Sjogren's Syndrome; Skin diseases; Social Class; Socioeconomic factors; Socioeconomic status; Socioeconomics; Statistics; Systemic lupus erythematosus; Systemic sclerosis; Thyroid; Thyroid diseases; Thyroid gland; Thyroiditis; Thyroiditis - complications; Trends; Women
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(23)00457-9

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 disease