Comparative United States autoimmune disease rates for 2010-2016 by sex, geographic region, and race

Abstract

Purpose: AIDs may disproportionately impact specific racial groups, but autoimmune (AID) prevalence information by minority racial group is sparse for many AIDs. The objective of this analysis was to supplement previously published AID prevalence rates by providing information on race rate ratios (minority race populations compared to Caucasian populations) in the United States. Preliminary to estimating race rate ratios, contemporary US-specific, health care utilization-based AID prevalence rates and female-to-male ratios were estimated and compared to previously published AID prevalence rates.

Methods: We used a large national electronic medical record database of 52 million individuals to estimate age-adjusted direct standardized rates for 22 AIDs for 2010 through 2016 by gender, race, and US census division. These were compared to previously published estimates.

Results: Female-to-male ratios were comparable with published studies. Almost all observed Multiracial AID rates were significantly higher than Caucasian rates, as well as 9 of 22 AID rates observed among Native Americans and 8 of 22 AID rates estimated among African-American patients. Regional variation was noted: highest African-American systemic lupus erythematosus rates were observed in the West North Central and South Atlantic divisions, highest African-American multiple sclerosis rates in the South Atlantic and Pacific divisions, and highest Native American rheumatoid arthritis rates in the West North Central, Mountain, and Pacific divisions.

Conclusions: Substantial AID heterogeneity exists by race and by geographic area. An important research area is further exploring factors related to heterogeneity such as potential interactions between genetic susceptibility and environmental factors.

Keywords: Autoimmune disease; Minority groups; North American; Prevalence.

Figure 1.

US Census Regions and Divisions Depicted on the map of the United States (US) are the four US census regions (Northeast, South, Midwest, West) and nine US census divisions.

Figure 2.

Standardized AID Rates, United States, 2010–2016 AID, autoimmune disorders; CIDP, chronic inflammatory demyelinating polyneuropathy * AID with observed rate of 50 per 100,000 or higher Depicted are observed rates and 95% confidence intervals estimated from the Health Facts database population for the years 2010–2016, and the ranges for the published comparison rates.[2] All rates are per 100,000. Observed rates are age-adjusted to the 2000 US Census population.

Figure 3.

Standardized AID Rate Ratios, Female vs Male, United States, 2010–2016 AID, autoimmune disorder; CIDP, chronic inflammatory demyelinating polyneuropathy * AID with observed rate of 50 per 100,000 or higher Depicted are for the comparison and observed ratios. Comparison ratios are point estimates based on female percentage reported by Hayter and Cook.[2] Observed ratios are standardized age-adjusted observed rates for female vs male estimated from the Health Facts database population for the years 2010–2016, and the associated 95% confidence intervals for the ratios.

Figure 4.

Standardized AID Rate Ratios, Minority Race vs Caucasian, United States, 2010–2016 AID, autoimmune disorder; CIDP, chronic inflammatory demyelinating polyneuropathy * AID with observed rate of 50 per 100,000 or higher Depicted are the standardized age-adjusted observed rate ratios, estimated from the Health Facts database population for the years 2010–2016, for each race vs Caucasian, and the associated 95% confidence intervals for the ratios.

Figure 5.

Standardized AID Rate Ratios for AIDs with Overall Observed Rates of 50 per 100,000 or Higher, Minority Race vs Caucasian, by Census Division, United States, 2010–2016 E, east; N, north; S, south; W, west Depicted are the standardized age-adjusted observed rate ratios, estimated from the Health Facts database population for the years 2010–2016, for each race vs Caucasian within each US Census Division, and the associated 95% confidence intervals for the ratios. US Census Regions/Divisions and states included are: Northeast/New England (CT, ME, MA, NH, RI, VT); Northeast/Middle Atlantic (NJ, NY, PA); Midwest/West North Central (IA, KS, MN, MO, ND, SD); Midwest/East North Central (IL, IN, MI, OH, WI); South/East South Central (AL, KY, MS, TN); South/South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV); South/West South Central (AR, LA, OK, TX); West/Mountain (AZ, CO, ID, MT, NV, NM, UT, WY); West/Pacific (AK, CA, HI, OR, WA). There were no observations identified for MS for Native Americans in the East South Central Census Division, and only 3 or less for diabetes mellitus type 1, rheumatoid arthritis, and systemic lupus erythematosus.