Global incidence and prevalence of autoimmune hepatitis, 1970-2022: a systematic review and meta-analysis

Jong Woo Hahn; Hye Ran Yang; Jin Soo Moon; Ju Young Chang; Kwanjoo Lee; Gi Ae Kim; Masoud Rahmati; Ai Koyanagi; Lee Smith; Min Seo Kim; Guillermo F López Sánchez; Dragioti Elena; Ju-Young Shin; Jae Il Shin; Rosie Kwon; Soeun Kim; Hyeon Jin Kim; Hojae Lee; Jae Sung Ko; Dong Keon Yon

doi:10.1016/j.eclinm.2023.102280

Global incidence and prevalence of autoimmune hepatitis, 1970-2022: a systematic review and meta-analysis

EClinicalMedicine. 2023 Oct 17:65:102280. doi: 10.1016/j.eclinm.2023.102280. eCollection 2023 Nov.

Authors

Jong Woo Hahn^{1

2}, Hye Ran Yang^{1

2}, Jin Soo Moon¹, Ju Young Chang¹, Kwanjoo Lee³, Gi Ae Kim⁴, Masoud Rahmati^{5

6}, Ai Koyanagi⁷, Lee Smith⁸, Min Seo Kim⁹, Guillermo F López Sánchez¹⁰, Dragioti Elena^{11

12}, Ju-Young Shin¹³, Jae Il Shin¹⁴, Rosie Kwon^{15

16}, Soeun Kim^{15

16}, Hyeon Jin Kim^{15

16}, Hojae Lee^{15

16}, Jae Sung Ko¹, Dong Keon Yon^{15

16

17}

Affiliations

¹ Department of Paediatrics, Seoul National University College of Medicine, Seoul, South Korea.
² Department of Paediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.
³ Digestive Disease Centre, CHA Bundang Medical Centre, CHA University School of Medicine, Seongnam, South Korea.
⁴ Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea.
⁵ Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran.
⁶ Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran.
⁷ Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain.
⁸ Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.
⁹ Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹⁰ Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain.
¹¹ Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
¹² Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece.
¹³ School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
¹⁴ Department of Paediatrics, Yonsei University College of Medicine, Seoul, South Korea.
¹⁵ Centre for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
¹⁶ Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.
¹⁷ Department of Paediatrics, Kyung Hee University Medical Centre, Kyung Hee University College of Medicine, Seoul, South Korea.

Abstract

Background: Autoimmune hepatitis (AIH) varies significantly in incidence and prevalence across countries and regions. We aimed to examine global, regional, and national trends in incidence and prevalence of AIH from 1970 to 2022.

Methods: We conducted a thorough search of the PubMed/MEDLINE, Embase, CINAHL, Google Scholar, and Cochrane databases from database inception to August 9, 2023, using the search term "autoimmune hepatitis" in combination with "incidence," "prevalence," or "trend." Only general population-based observational studies with larger samples sizes were considered for inclusion. Studies that recruited convenience samples, and those with fewer than 50 participants were excluded. Summary data were extracted from published reports. A random effects model was used and pooled estimates with 95% CI were used to calculate the incidence and prevalence of AIH. Heterogeneity was evaluated using the I² statistic. The study protocol was registered with PROSPERO, CRD42023430138.

Findings: A total of 37 eligible studies, encompassing more than 239 million participants and 55,839 patients with AIH from 18 countries across five continents, were included in the analysis. Global pooled incidence and prevalence of AIH were found to be 1.28 cases per 100,000 inhabitant-years (95% CI, 1.01-1.63, I² = 99·51%; number of studies, 33; sample population, 220,673,674) and 15.65 cases per 100,000 inhabitants (95% CI, 13.42-18.24, I² = 99·75%; number of studies, 26; sample population, 217,178,684), respectively. The incidence of AIH was greater in countries with high Human Development Index (>0.92), in North America and Oceania (compared with Asia), among females, adults (compared with children), and high latitude (>45°). Similar patterns in AIH prevalence were observed. Pooled AIH prevalence increased gradually from 1970 to 2019 (1970-1999; 9.95 [4.77-15.13], I² = 95·58% versus 2015-2022; 27.91 [24.86-30.96], I² = 99·32%; cases per 100,000 inhabitants). The overall incidence and prevalence of AIH, as well as some subgroup analyses of the studies, displayed asymmetry in the funnel plots, suggesting potential evidence of publication bias.

Interpretation: AIH incidence and prevalence have increased significantly and exhibit substantial variation across regions worldwide. Further research is required to assess the incidence and prevalence of AIH, specifically in South America and Africa.

Funding: National Research Foundation of Korea.

Keywords: Autoimmune hepatitis; Global trend; Incidence; Prevalence; Systematic review and meta-analysis.