Bridging Gaps in Diagnosis, Treatment, and Awareness

Autoimmunity has traditionally been associated with developed Western countries, with some studies showing a higher incidence rate in industrial regions such as Northern Europe and North America. According to one study, autoimmune diseases cumulatively affect 5 to 10% of the industrial world population (1) (2). Other studies have shown that the prevalence of autoimmune disease in developing countries is lower (3) but on the rise (4). 

That being said, the exact percentage of the world’s population affected by autoimmune diseases is not well documented. The prevalence of autoimmune diseases can vary greatly between countries and regions, and the general discrepancy between developing and developed has been a subject of research and debate among scientists and healthcare professionals.

Sandro Vento, Dean of the Faculty of Medicine at the University of Puthisastra, who has studied autoimmune hepatitis, says it is virtually impossible to know what percentage of people or how many are affected by autoimmune diseases. 

“The number of studies is extremely small,” he says. “With so few reports and so few studies, researchers must rely on a small number of studies to extrapolate and estimate the prevalence rate.” 

One study published in 1968 in The Lancet, for example, noted that in a Nigerian hospital, there were few autoimmune diseases. 

Vento has one response: “I’m not convinced.”

Autoimmune Disease in the Industrialized World vs Developing Countries

Many studies have explained a higher prevalence of autoimmune diseases in developed countries to be the impact of environmental factors, such as pollution and diet. Exposure to certain chemicals, toxins, and pollutants in the environment has also been found to increase the risk of developing autoimmune diseases. Determinants include diminished ultraviolet radiation exposure, a Western or affluence-related lifestyle, infection exposure, nutritional factors, and disease-specific precipitants like iodine exposure (1). 

Additionally, the Western diet, which is high in processed foods, saturated fats, and sugar, has been linked to the development of autoimmune diseases. According to one study, commonly used industrial food additives, such as glucose, salt, emulsifiers, organic solvents, gluten, microbial transglutaminase, and nanoparticles, all increase intestinal permeability and the subsequent activation of the autoimmune cascade (5).

Genetic factors are another underlying issue which have been found to predispose an individual to an autoimmune condition. Among patients with systemic lupus erythematosus (SLE), for example, certain ethnic groups have been found to be more vulnerable than others, and the prevalence and mortality of the disease vary widely between geographic regions (6).

The epidemiology of multiple sclerosis (MS) also demonstrates the role of ethno-genetic factors. According to one study, MS is significantly more prevalent in Whites compared to Blacks and Asians. Some ethnic populations also seem disease-resistant, such as Northern Norwegians, Australian Aboriginals, New Zealand Maoris, natives of the Southern part of the former Soviet Union, and North and South American Indians (1). 

Geographic Differences in Diagnostics & Treatment for Autoimmune Disease

Worldwide inequities and gaps in access to healthcare and data mean that the diagnosis and treatment of autoimmune diseases can differ significantly (7), which is a prime reason that much remains unknown. 

“There is a huge lack of knowledge in many developing countries, and this makes diagnosis really difficult. It also explains why the number of cases and the overall prevalence of autoimmune diseases are likely to be understated,” says Vento. 

In developed countries, healthcare systems have advanced diagnostic tools and technology, which often allows for early detection and diagnosis. This includes access to laboratory tests, imaging studies, and specialized clinics for autoimmune disorders. Additionally, healthcare professionals in developed countries may have more training and experience with autoimmune diseases, which can lead to a more accurate diagnosis and management. Immunosuppressant drugs, biologics, and other targeted therapies can also help to reduce inflammation and slow the progression of diseases. 

In contrast, healthcare systems in developing countries may have limited access to similar tools and technology. In some countries, it can be difficult for people with autoimmune diseases to receive a proper diagnosis due to a lack of funding, a lack of trained healthcare professionals, and the limited availability of diagnostic tests (1). 

“In a huge number of developing countries, there aren’t many rheumatologists or specialized doctors, so the diagnosis is likely to be much less than the real number of patients with these diseases,” says Vento. 

A broader lack of awareness around the burden of autoimmune disease is also a contributing factor. Since there are so many autoimmune diseases, and each individual disease is largely considered to be rare with the exception of rheumatoid arthritis, they’re not top of mind. 

In addition to diagnosis delays, patients and medical providers are often unaware of what autoimmune disease involves. Non-specific symptoms can also make them difficult to diagnose. In many developing countries, treatments may be more limited and less effective, or they may focus on symptom management, such as pain relief and non-steroidal anti-inflammatory drugs (NSAIDs), which can lead autoimmune diseases to progress unchecked. 

“There may be more cases, but we cannot be sure, because even though Western countries also have problems in diagnosing autoimmune diseases, laboratories, and facilities are much more developed, and there are huge numbers of doctors and specialists,” Vento says. “It’s easier to make a diagnosis and receive patients in developed Western countries, but it’s much more difficult for a patient to present themselves to hospitals in developing countries where the doctor makes the right diagnosis.”

What can be done?

There are several additional strategies that can be implemented to combat autoimmune diseases:

Increasing awareness and education: Raising awareness about autoimmune diseases and their symptoms more broadly can help patients and medical providers seek early diagnosis and treatment, which can improve outcomes and reduce disease severity.

Improving access to healthcare: In developing countries, access to healthcare is often limited, which can make it difficult for people with autoimmune diseases to receive proper diagnosis and treatment. Improving access to drugs, diagnostic tools, and treatments can help reduce the burden of autoimmune diseases. 

Developing new treatments: Discovering more effective treatments is key to better management of autoimmune diseases. This can include therapies that target specific immune cells involved in the disease, as well as new drugs that have fewer side effects than current options.

Addressing environmental factors: Identifying and addressing environmental factors that contribute to the development of autoimmune diseases, such as exposure to toxins and pollutants, can help reduce the risk of conditions in both developed and developing countries.

Filling gaps in data collection: Gaining epidemiologic, demographic, and clinical data is essential to having a better understanding of diseases and improving patient outcomes.

Promoting healthy lifestyles: Encouraging healthy lifestyle choices, such as regular exercise, healthy eating, and stress management, can help reduce the risk of autoimmune diseases. 

Advancing research: By understanding the underlying causes of autoimmune diseases, scientists can develop new treatments and prevention strategies that can help reduce the burden of conditions worldwide.

According to Vento, developing countries often rely on guidance from the World Health Organization to determine health policy. Historically, the WHO has focused on infectious diseases, such as HIV and tuberculosis. While it’s recently begun to pay closer attention to non-communicable diseases, it still hasn’t issued guidance on autoimmune disease. 

“It is important to raise awareness, particularly with governments in developing countries, in addition to increasing coordination with the WHO,” says Vento. “If the WHO could more clearly establish the prevalence of autoimmune diseases in developing countries, it could push governments to do something more.”

Carolyn Serraino

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