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Meta-Analysis
. 2019 Dec:105:102303.
doi: 10.1016/j.jaut.2019.07.002. Epub 2019 Jul 25.

Changing epidemiology of immune-mediated inflammatory diseases in immigrants: A systematic review of population-based studies

Manasi Agrawal  1 , Shailja Shah  2 , Anish Patel  3 , Rachel Pinotti  4 , Jean-Frederic Colombel  5 , Johan Burisch  6
Affiliations
Meta-Analysis

Changing epidemiology of immune-mediated inflammatory diseases in immigrants: A systematic review of population-based studies

Manasi Agrawal et al. J Autoimmun. 2019 Dec.

Abstract

Background: Immune-mediated inflammatory diseases (IMIDs) are systemic diseases of multifactorial etiology that share aberrant immune responses as the common final pathway. With rising globalization, their incidence is increasing in developing countries and among immigrants. Our primary objective was to systematically review the epidemiology of IMIDs in immigrants and conduct a meta-analysis to estimate the risk of IMIDs in immigrant populations according to their origin and destination countries.

Methods: We systematically searched five biomedical databases and reviewed population-based studies, from inception through August 2018, that reported incidence or prevalence data of inflammatory bowel disease (IBD), multiple sclerosis (MS), type 1 diabetes (T1D), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) or psoriasis and psoriatic arthritis (PPA) among immigrants and the host population.

Results: The incidence and prevalence of IMIDs among immigrants differ from host populations, and evolve over subsequent generations. The risk of IBD among immigrants approximates that in hosts, especially among South Asians, with ulcerative colitis incidence changing prior to Crohn's disease incidence. MS risk is highest in Iranian immigrants, T1D in African immigrants and SLE in African and Iraqi immigrants. Data on other IMIDs are sparse. Significant heterogeneity between the studies precluded meta-analysis.

Conclusion: Based on our systematic review, the epidemiology of IMIDs among immigrants varies according to native and host countries, immigrant generation, and IMID type. The rapid evolution suggests a role for non-genetic factors and gene-environment interactions. Future studies should focus on these pattern shifts, given implications of rising global burden of IMIDs and immigration.

Keywords: Autoimmunity; Epidemiology; Immigration; Immune-mediated inflammatory diseases; Population-based studies; Systematic review.

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Figures

Figure 1:
Figure 1:
PRISMA 2009 flow diagram, all immune-mediated inflammatory diseases
Figure 2:
Figure 2:
Change in immune-mediated inflammatory diseases (IMIDs) epidemiology with migration from developing to developed countries
Figures 3
Figures 3
a and b: Number of new IMID cases among immigrants between 2008 and 2017, based on references (12, 13, 24, 44, 57, 71)
Figure 4:
Figure 4:
Number of new IBD cases in minority immigrants to Canada in 2010 and projected number in 2036 based on references (35) and (99)
See this image and copyright information in PMC

References

    1. El-Gabalawy H, Guenther LC, Bernstein CN. Epidemiology of immune-mediated inflammatory diseases: incidence, prevalence, natural history, and comorbidities. J Rheumatol Suppl. 2010;85:2–10. - PubMed
    1. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet (London, England). 2018;390(10114):2769–78. - PubMed
    1. Ng SC, Tang W, Leong RW, Chen M, Ko Y, Studd C, et al. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut. 2015;64(7):1063–71. - PubMed
    1. Arah OA, Ogbu UC, Okeke CE. Too poor to leave, too rich to stay: developmental and global health correlates of physician migration to the United States, Canada, Australia, and the United kingdom. American journal of public health. 2008;98(1):148–54. - PMC - PubMed
    1. Jacobs P, Bissonnette R, Guenther LC. Socioeconomic burden of immune-mediated inflammatory diseases--focusing on work productivity and disability. J Rheumatol Suppl. 2011;88:55–61. - PubMed