Prevalence and sociodemographic correlates of antinuclear antibodies in the United States

Abstract

Objective: To estimate the prevalence, types, and sociodemographic and biobehavioral correlates of antinuclear antibodies (ANAs) in the US.

Methods: We conducted a cross-sectional analysis of 4,754 individuals from the National Health and Nutrition Examination Survey 1999-2004. ANAs were assessed by indirect immunofluorescence. In ANA-positive individuals, cellular staining patterns were determined, and specific autoantibody reactivities were assessed by immunoprecipitation.

Results: The ANA prevalence in the US population of individuals ages 12 years and older was 13.8% (95% confidence interval [95% CI] 12.2-15.5%). ANA prevalence increased with age (P=0.01), and ANAs were more prevalent among females than males (17.8% versus 9.6%; P<0.001), with the female-to-male ratio peaking at 40-49 years of age. ANA prevalence was modestly higher in African Americans compared with whites (age-adjusted prevalence odds ratio [POR] 1.30, 95% CI 1.00-1.70). Remarkably, ANAs were less common in overweight and obese individuals (age-adjusted POR 0.74) than in persons of normal weight. No significant associations of ANA with education, family income, alcohol use, smoking history, serum levels of cotinine, or C-reactive protein were observed. In ANA-positive individuals, nuclear patterns were seen in 84.6%, cytoplasmic patterns were seen in 21.8%, and nucleolar patterns were seen in 6.1%; the most common specific autoantibodies were anti-Ro (3.9%) and anti-Su (2.4%).

Conclusion: These findings suggest that more than 32 million persons in the US have ANAs, and that the prevalence is higher among females, older individuals, African Americans, and those with a normal body weight. These data will serve as a useful baseline for future investigations of predictors and changes in ANA prevalence over time.

Figure 1

Estimated Prevalence (with 95% confidence intervals) of antinuclear antibodies (ANA) across age groups by sex An asterisk (*) denotes significant differences in estimated ANA prevalences between females and males (P Value<0.05).

Figure 2

Estimated prevalence of antinuclear antibodies (ANA), with 95% confidence intervals, across age groups by race/ethnicity* ^* There were no significant differences among racial/ethnic groups in estimated ANA prevalence in the individual decades. The "Other" race/ethnic group is not displayed though it was included in significance testing.

Figure 3

Estimated prevalence odds ratios for female compared to male ANA prevalence (with 95% confidence intervals) by age groups