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Review
. 2024 Aug 9:8:100158.
doi: 10.1016/j.gloepi.2024.100158. eCollection 2024 Dec.

Incidence and prevalence of autoimmune diseases in China: A systematic review and meta-analysis of epidemiological studies

Olaa Mohamed-Ahmed  1   2 , Lianhan Shang  1 , Lin Wang  1 , Zhengming Chen  1   3 , Christiana Kartsonaki  1   3 , Fiona Bragg  1   3
Affiliations
Review

Incidence and prevalence of autoimmune diseases in China: A systematic review and meta-analysis of epidemiological studies

Olaa Mohamed-Ahmed et al. Glob Epidemiol. .

Abstract

Background: Autoimmune diseases account for a substantial burden of disease in high-income countries, including Europe and North America. However, their epidemiology remains under-researched in other regions. We examined the incidence and prevalence of eight autoimmune diseases in the adult Chinese population through a systematic review of epidemiological studies.

Methods: We searched OvidSP MEDLINE and Google Scholar from 1995 to 2023 (inclusive) for articles on the incidence or prevalence of autoimmune thyroiditis (AT), Graves' disease (GD), type 1 diabetes mellitus (T1D), multiple sclerosis (MS), Crohn's disease (CD), ulcerative colitis (UC), rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We included studies from mainland China, Taiwan, Hong Kong or Macau. The study is registered with PROSPERO (CRD42021225842).

Findings: We retrieved 2278 records, of which 62 studies (161 estimates) were included in the systematic review, and 42 studies (101 estimates) were included in the meta-analysis. Pooled fixed-effects estimates for incidence of CD, UC, MS, T1D and SLE were 0.22 (95% CI 0.21-0.23), 1.13 (1.10-1.17), 0.28 (0.26-0.30), 2.20 (1.70-2.84) and 4.87 (4.21-5.64) per 100,000 persons, respectively. For RA, one study estimate was included, with an incidence of 15.8 per 100,000 persons. Fixed-effects estimates for the prevalence of CD, UC, MS, SLE, RA, GD and AT were 3.73 (95% CI 3.68-3.78), 16.11 (15.93-16.29), 4.08 (3.95-4.21), 93.44 (92.27-94.63), 104 (103-106), 450 (422-481) and 2322 (2057-2620), respectively, per 100,000 persons. Across all conditions, women were almost twice as likely as men to be diagnosed with an autoimmune disease.

Interpretation: There is marked variation in the frequency of autoimmune diseases among Chinese adults. We estimate that 2.7-3.0% (>31 million people) of the adult Chinese population have one or more autoimmune diseases, comparable to Western populations, with the majority of the burden from autoimmune thyroid diseases and rheumatoid arthritis.

Keywords: Autoimmune conditions; Autoimmune diseases; Autoimmunity; China; Crohn's disease; Epidemiology; Graves' disease; Hashimoto disease; Multiple sclerosis; Ulcerative colitis.

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Conflict of interest statement

We declare no competing interests.

Figures

Fig. 1
Fig. 1
Study selection. Full-text articles could have been excluded for more than one reason; only the primary reason for exclusion is listed here. Some studies included more than one autoimmune condition, and, thus, the sum of the number of studies included for each autoimmune condition does not equal the total number of included studies. Adapted From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71 [16].
Fig. 2
Fig. 2
Incidence of autoimmune diseases. * Standardised incidences presented for Ng 2016 and Tian 2020. All other studies present crude annual incidence. AS/R = Active surveillance or registry, RH = Routine healthcare data, S = Survey.
Fig. 3
Fig. 3
Prevalence of autoimmune diseases (low prevalence). AS/R = Active surveillance or registry, RH = Routine healthcare data, S = Survey.
Fig. 4
Fig. 4
Prevalence of autoimmune diseases (high prevalence). AS/R = Active surveillance or registry, RH = Routine healthcare data, S = Survey, (ID) = iodine deficient, (IA) = iodine adequate, (IE) = iodine excessive, (Z) = Zhuang ethnicity, (H) = Han ethnicity.
See this image and copyright information in PMC

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