Prevalence of Noninfectious Uveitis in the United States

Abstract

IMPORTANCE Noninfectious uveitis (NIU) is a collection of intraocular inflammatory disorders that may be associated with significant visual impairment. To our knowledge, few studies have investigated NIU prevalence overall or stratified by inflammation location, severity, presence of systemic conditions, age, or sex. OBJECTIVE To estimate NIU prevalence using a large, retrospective, administrative claims database. DESIGN, SETTING, AND PARTICIPANTS This analysis used the OptumHealth Reporting and Insights database to estimate 2012 NIU prevalence. Analysis was conducted in September 2016. The large administrative insurance claims database includes 14 million privately insured individuals in 69 self-insured companies spanning diverse industries. Included in the study were patients with NIU with 2 or more uveitis diagnoses on separate days in 2012 and continuous enrollment in a health plan for all of 2012 and categorized by inflammation site. MAIN OUTCOMES AND MEASURES We estimated overall NIU prevalence by inflammation site, severity, sex, and age. Patients with anterior NIU were categorized by the presence of systemic conditions. RESULTS Of the approximately 4 million eligible adult patients, approximately 2.1 million were women, and of the 932 260 children, 475 481 were boys. The adult prevalence of NIU was 121 cases per 100 000 persons (95% CI, 117.5-124.3). The pediatric NIU prevalence was 29 cases per 100 000 (95% CI, 26.1-33.2). Anterior NIU accounted for 81% (3904 cases) of adult NIU cases (98 per 100 000; 95% CI, 94.7-100.9) and 75% (207 cases) of pediatric NIU cases (22 per 100 000; 95% CI, 19.3-25.4). The prevalences of noninfectious intermediate, posterior, and panuveitis were, for adults, 1 (95% CI, 0.8-1.5), 10 (95% CI, 9.4-11.5), and 12 (95% CI, 10.6-12.7) per 100 000, respectively, and for pediatric patients, 0 (95% CI, 0.1-1.1), 3 (95% CI, 1.8-4.1), and 4 (95% CI, 2.9-5.6) per 100 000, respectively. The prevalence of NIU increased with age and was higher among adult females than males. Application of these estimates to the US population suggests that NIU affected approximately 298 801 American adults (95% CI, 290 512-307 324) and 21 879 children (95% CI, 19 360-24 626) in 2015. CONCLUSIONS AND RELEVANCE The estimated prevalence of NIU was 121 cases per 100 000 for adults (95% CI, 117.5-124.3) and 29 per 100 000 for children (95% CI, 26.1-33.2). Prevalence was estimated using administrative claims from a commercially insured population, which may have a different prevalence than other segments of the US population. A better understanding of the prevalence of NIU will help to determine the number of patients affected.

The Role of Estradiol in Idiopathic Anterior Uveitis during the Eumenorrheic Stage of Life

“…Idiopathic autoimmune uveitis is the single most common cause of uveitis. [1] Autoimmune disorders affect nearly 20 million Americans. [2] Many of these disorders are found to be more common in women than men.…”

“…[3,4] Similar to other autoimmune diseases, women have a higher prevalence of anterior noninfectious uveitis than men. [1] There is a significant body of literature on the biological differences between men and women that may affect the course of autoimmune disease. Differences in female sex steroid hormones are likely responsible for the dissimilarity in disease course between males and females.…”

Biologic therapy for uveitis: a new beginning

“…Most other clinical phenotypes of uveitis involve the posterior segment of the eye, behave differently and have a broad range of uveitis severity . Intermediate, posterior and panuveitis although far less frequent than AAU are frequently vision threatening, and commonly need systemic corticosteroid and additional immunosuppressive therapy to control the uveitis.…”

Prevalence of the Uveitides in the United States

“…Their prevalence estimate is remarkably similar to the population-based Northern California Epidemiology of Uveitis Study, which found an all-ages prevalence of all uveitides of 115.3 per 100 000 persons among persons enrolled in the Kaiser Permanente Health Plan. 5 As noted in the article by Thorne et al, 4 studies of populations that are nonrepresentative of the US population in general and that oversample subpopulations with a lower incidence of uveitis will give lower overall estimates of the prevalence of the uveitides. One limitation of the analysis by Thorne et al 4 was the absence of data on race and ethnicity, which might have provided insight into regional variations in the prevalence and types of uveitis.…”

“…5 As noted in the article by Thorne et al, 4 studies of populations that are nonrepresentative of the US population in general and that oversample subpopulations with a lower incidence of uveitis will give lower overall estimates of the prevalence of the uveitides. One limitation of the analysis by Thorne et al 4 was the absence of data on race and ethnicity, which might have provided insight into regional variations in the prevalence and types of uveitis. There were other limitations to this study.…”