Глобальное, региональное и национальное бремя аутоиммунных заболеваний у пожилых людей≥60 лет) от 1990 в адрес 2021:: Результаты глобального исследования бремени болезней 2021.

Introduction

Autoimmune diseases (ADs) are the third most prevalent disease category worldwide, following cancer and cardiovascular diseases [ 1 ]. They encompass a heterogeneous group of disorders characterized by chronic inflammation and progressive tissue damage, arising from immune system dysfunction and impaired self-tolerance [ 2 ]. Such maladaptive immune response can target virtually any organ or system, leading to widespread tissue destruction and diverse clinical manifestations [ 3 ]. Affecting nearly 10% of the global population, ADs impose a growing health and economic burden by straining healthcare resources and reducing quality of life [ 4 ].

With rising global life expectancy, research on aging has gained considerable focus. Aging is marked by a gradual decline in tissue and organ function, affecting overall health and resilience [ 5 ]. This process involves a steady reduction in immune function, termed "immunosenescence", often accompanied by persistent low-grade inflammation, known as "inflammaging" [ 6 ]. As the immune system ages, both innate and adaptive immune undergo profound changes that drive immunosenescence: innate immune activity tends to increase, while adaptive immune function declines, elevating the risk of ADs in older adults [ 7 ]. In this population, ADs are often linked to poor prognosis and prolonged hospitalizations stays, contributing to diminished quality of life and increased healthcare costs. These impacts extend beyond individuals to burden families and healthcare systems [ 8 ].

Although recent evidence suggests improvements in life expectancy among individuals with ADs, comprehensive data on the burden of these conditions remain scarce in many countries and regions [ 9 ]. Moreover, existing clinical guidelines and management practices generally lack tailored recommendations for addressing ADs in older adults [ 10 ].

In this study, we utilized data from the Global Burden of Disease (GBD) 2021 dataset to examine the global, regional, and national burden of five ADs—rheumatoid arthritis (RA), inflammatory bowel disease (IBD), multiple sclerosis (MS), type 1 diabetes mellitus (T1DM), and psoriasis--among older adults aged ≥60 years. We calculated age-standardized rates of incidence (ASIR), prevalence (ASPR), mortality (ASMR) and disability-adjusted life years (DALYs) (ASDR) and analyzed temporal trends over the past three decades. This comprehensive assessment is intended to provide critical insights to inform global strategies for the prevention and management of ADs in aging populations.

Methods

Data sources

This study utilized anonymized, publicly available data from GBD 2021, which evaluates the global burden of 371 diseases and 88 risk factors across 204 countries and five Socio-Demographic Index (SDI) regions [ 11 , 12 ]. Data were obtained from the Global Health Data Exchange (GHDx), which is curated by the Institute for Health Metrics and Evaluation (IHME). The GBD provides standardized estimates of prevalence, incidence, deaths, and DALYs. These metrics are reported as absolute numbers, crude rates, and age-standardized rates per 100,000 population.

Ethical approval was not required because this study used open-access data. The study adhered to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) to ensure transparency and methodological rigor [ 13 ].

Definition of ADs

In this study, ADs were defined and classified based on clinical criteria established by the World Health Organization (WHO) and the International Classification of Diseases, 10th Revision (ICD-10). The specific ICD-10 codes used for each condition were as follows: Rheumatoid Arthritis (RA) (M05-M05.9, M08-M09.8), Inflammatory Bowel Disease (IBD) (K50 [Crohn’s disease], K51 [Ulcerative colitis], K52 [Indeterminate colitis], K52.8 [Other specified noninfective gastroenteritis and colitis], K52.9 [Noninfective gastroenteritis and colitis, unspecified]), Multiple Sclerosis (MS) (G35-G35.0), Type 1 Diabetes Mellitus (T1DM) (E10-E10.11, E10.3-E10.9), and Psoriasis (L40-L41.9). Using these standardized codes ensured consistent diagnosis and classification across the study population, aligning with international standards ( https://icd.who.int/browse10/2019/en ).

SDI and decomposition methodology

The SDI is a composite metric that reflects a population’s overall development and is closely linked to health outcomes. It is calculated as the geometric mean of three key indicators: the total fertility rate among individuals under 25 years of age, the average education attainment of those aged 15 years and older, and a lag-distributed per capita income measure. The SDI ranges from 0 to 1, with higher values indicating greater development [ 11 ]. In this study, we employed a decomposition approach to analyze incidence, prevalence, mortality, and DALYs for five ADs. This method accounted for variations attributable to changes in population age structure, population growth, and temporal epidemiological shifts [ 14 ], thereby providing insights into the key drivers of AD burden at the population level.

Projection analysis

We employed the Bayesian age-period-cohort (BAPC) model to project the incidence, prevalence and DALYs associated with ADs from 2022 to 2035. The age-period-cohort model is a log-linear Poisson regression framework that assumes multiplicative effects of age, period, and cohort with a suitable link function relating predictors to outcomes [ 15 ]. Using data form 2021 as the baseline, we estimated future burden of five ADs and compared these projections to the ASIR, ASPR, ASMR and ASDR for ADs in 2021. To explore potential future scenarios, we considered a pessimistic reference with a 1% annual increase and an optimistic scenario with a 1% annual decrease in these rates. The BAPC model was implemented using the R package “BAPC” to generate these forecasts.

Statistical analysis

An analysis was conducted to assess the disease burden of five major ADs from 1990 to 2021. Results were presented as counts, age-specific rates, and age-standardized rates (ASRs) per 100,000 persons. The GBD 2021 study used the GBD standard population structure as the reference for calculating ASRs [ 11 ]. All disease burden estimates were reported as mean values with 95% uncertainty intervals (UIs), derived from the 2.5th and 97.5th percentiles of 1000 simulations. Temporal trends were assessed using the estimated annual percentage change (EAPC) with 95% confidence intervals (CIs). EAPC, derived from a log-linear regression model, reflects the average annual percentage change in ASRs, with positive values indicating increases and negative values indicating decreases [ 16 ]. Statistical analyses were performed using the Joinpoint Regression program (version 5.0.2) and R software (version 4.2.1), with P < 0.05 considered statistically significant.

Results

Global incidence, prevalence, mortality and DALYs

In 2021, among adults aged ≥60 years, the ASIR was highest for psoriasis (91.56 per 100,000 persons), followed by RA (17.84 per 100,000 persons), IBD (8.71 per 100,000 persons), T1DM (3.94 per 100,000 persons), and MS (0.31 per 100,000 persons). From 1990 to 2021, ASIR of RA, IBD, T1DM, and psoriasis showed significant upward trends, with EAPCs of 0.75, 0.38, 0.78, and 0.24, respectively, whereas MS incidence declined (EAPC = −0.30) ( Table 1 , Fig. 1 ).

Table 1 Global incidence, prevalence, mortality, and DALYs of 5 autoimmune diseases from 1990 to 2021. Table 1 Year RA IBD MS T1DM Psoriasis 1990 Incidence (95% UI) 123945.06(78947.83, 176323.84) 38999.98(29941.58,49299.10) 1659.89(1172.55,2080.18) 14135.03(6293.98,26722.76) 426185.35(373576.30,483302.73) Prevalence (95% UI) 3074297.77(2663033.90, 3566184.75) 573502.7(467919.7,692476.5) 252617.3(218238.5,291025.3) 1507607.28(1287398.32,1778063.80) 4760556.24(4420510.46,5121637.67) Mortality (95% UI) 140.65(96.10,180.8) 14402.29(12026.90,16137.24) 3976.61(3737.80,4181.09) 10291.57(8578.95,12138.91) – DALYs (95% UI) 5051.49(3934.25,6311.82) 324103.10(273964.50,371032.00) 148268.30(129695.80,170001.00) 343653.75(285874.50,407401.29) 386880.31(280406.28,505423.56) ASIR (1/100,000, 95% UI) 19.89(10.12,25.42) 7.99(6.14,10.12) 0.34(0.24,0.43) 3.04(1.38,5.71) 84.55(74.03,95.97) ASPR (1/100,000, 95% UI) 635.51(551.54,735.47) 118.37(96.42,143.20) 52.32(45.10,60.4) 313.61(267.56,369.95) 966.51(897.54,1039.59) ASMR (1/100,000, 95% UI) 5.21(3.56,6.72) 3.67(3.05,4.12) 0.83(0.78,0.88) 2.20(1.83,2.59) – ASDR (1/100,000, 95% UI) 163.92(127.43,204.60) 72.49(61.11,82.8) 30.05(26.22,34.5) 70.43(58.55,83.53) 78.24(56.80,102.17) 2021 Incidence (95% UI) 334290.74(218244.71, 467590.29) 95235.24(72775.39,119425.4) 3364.97(2369.76,4310.82) 42330.41(17432.32,82471.15) 1012454.37(886545.20,1147159.35) Prevalence (95% UI) 7919135.55(6902538.91,9101562.52) 1278194(1033028,1547279) 559854.55(499447.43,626284.48) 4494610.04(3791367.44,5356562.30) 11401429.49(10618777.93,12235655.04) Mortality (95% UI) 249.60(198.96,318.16) 33486.84(28313.97,38234.55) 9592.44(8696.13,10187.62) 13490.98(11516.78,15788.88) – DALYs (95% UI) 9929.97(7903.70,12364.60) 683754.10(582617.20,788423.30) 334788.92(293618.12,378545.13) 659116.74(521876.73,820174.92) 921810.46(670221.35,1203374.81) ASIR (1/100,000, 95% UI) 17.84(10.76,26.64) 8.71(6.65,10.93) 0.31(0.22,0.40) 3.94(1.63,7.66) 91.56(80.15,103.80) ASPR (1/100,000, 95% UI) 726.91(634.05,834.80) 117.20(94.69,142.00) 51.37(45.80,57.5) 414.23(349.38,493.63) 1039.84(968.51,1115.81) ASMR (1/100,000, 95% UI) 4.44(3.50,5.69) 3.33(2.80,3.80) 0.89(0.80,0.94) 1.25(1.07,1.46) – ASDR (1/100,000, 95% UI) 149.58(119.25,186.03) 64.86(55.14,74.7) 30.55(26.77,34.5) 60.42(47.83,75.24) 83.97(61.08,109.60) 1990-2021 ASIR(EAPC,95%CI) 0.75(0.70, 0.79) 0.38(0.33, 0.42) −0.3(-0.33, -0.27) 0.78(0.70, 0.86) 0.24(0.22, 0.27) ASPR(EAPC,95%CI) 0.54(0.50, 0.58) 0.04(-0.02, 0.09) 0.13(0.06, 0.2) 0.84(0.81, 0.88) 0.23(0.22, 0.24) ASMR(EAPC,95%CI) −0.76(-0.83, -0.60) −0.11(-0.33,0.11) 0.38(0.32, 0.43) −2.09(-2.18, -1.99) – ASDR(EAPC,95%CI) −0.07(-0.11, -0.03) −0.24(-0.37, -0.11) 0.25(0.19, 0.31) −0.70(-0.78, -0.63) 0.22(0.21,0.23) RA rheumatoid arthritis, IBD inflammatory bowel disease, MS multiple sclerosis, T1DM type 1 diabetes mellitus, DALYs disability-adjusted life-years, ASIR age-standardized incidence rate, ASPR age-standardized prevalence rate, ASMR age-standardized mortality rate, ASDR age-standardized DALYs rate, EAPC estimated annual percentage change, CI confidence interval, UI uncertainty intervals.

Global incidence, prevalence, mortality, and DALYs of 5 autoimmune diseases from 1990 to 2021.

RA rheumatoid arthritis, IBD inflammatory bowel disease, MS multiple sclerosis, T1DM type 1 diabetes mellitus, DALYs disability-adjusted life-years, ASIR age-standardized incidence rate, ASPR age-standardized prevalence rate, ASMR age-standardized mortality rate, ASDR age-standardized DALYs rate, EAPC estimated annual percentage change, CI confidence interval, UI uncertainty intervals.

EAPCs of ASIR, ASDR and ASMR for five ADs globally and across 21 regions. EAPC , estimated annual percentage change; ASIR , age-standardized incidence rate; ASDR , age-standardized disability-adjusted life-years rate; ASMR , age-standardized mortality rate; ADs, autoimmune diseases.

Psoriasis remained the most prevalent ADs in this population in 2021, affecting 11.40 million older adults worldwide, with an ASPR of 1039.84 per 100,000 persons—substantially higher than other ADs. Moreover, its prevalence increased significantly over the past three decades (EAPC = 0.23). ASPRs of RA, MS, T1DM also rose, with T1DM exhibiting the steepest increase (EAPC = 0.84), followed by RA (0.54), and MS (0.13) ( Table 1 , Fig. 1 ).

In terms of ASMR, RA (4.44 per 100,000 persons) accounted for the highest burden of deaths, followed by IBD (3.33 per 100,000 persons), T1DM (1.25 per 100,000 persons), and MS (0.89 per 100,000 persons). The ASMRs for RA, IBD, and T1DM declined, most notably in T1DM (EAPC = −2.09). In contrast, MS was the only condition showing an increasing mortality trend (EAPC = 0.38) ( Table 1 , Fig. 1 ).

Regarding ASDR, RA contributed the greatest burden (149.58 per 100,000 persons), while MS showed the largest increase in ASDR over time (EAPC = 0.25). ASDRs for RA, IBD, and T1DM all declined, with T1DM experiencing the most significant reduction (EAPC = −0.70) ( Table 1 , Fig. 1 ).

Regional and national incidence, prevalence, mortality, and DALYs

Figs. 2 , S1, S2, Tables 2 and S1–S3 summarize the reginal and national burden of ADs among individuals aged ≥60 years. Regionally, South Asia exhibited the highest incidence of RA and MS. East Asia recorded the highest prevalence, mortality, and DALYs for RA, as well as the largest psoriasis burden. High-income North America bore the highest burden of IBD, including incidence, prevalence, and mortality, whereas Western Europe reported the highest IBD-related DALYs and led in the burden of MS and T1DM.

Maps showing ASIRs of rheumatoid arthritis(A), inflammatory bowel disease(B), multiple sclerosis(C), type 1 diabetes mellitus(D), and psoriasis(E) among individuals aged ≥60 years across countries in 2021. ASIR , age-standardized incidence rate.

Table 2 Regional incidence and ASIR of the 5 autoimmune diseases in 2021. Table 2 Location RA IBD MS T1DM Psoriasis Incidence (95% UI) ASIR (1/100,000, 95% UI) Incidence (95% UI) ASIR (1/100,000, 95% UI) Incidence (95% UI) ASIR (1/100,000, 95% UI) Incidence (95% UI) ASIR (1/100,000, 95% UI) Incidence (95% UI) ASIR (1/100,000, 95% UI) Global 334290.74 (218244.71, 467590.29) 30.32 (19.836,42.38) 95235.24(72775.39,119425.4) 8.71(6.65,10.93) 3364.97(2369.76,4310.82) 0.31(0.22,0.40) 42330.41(17432.32,82471.15) 3.94(7.66,1.63) 1012454.37(886545.20,1147159.35) 91.56(80.15,103.80) High SDI 114994.17(78215.01,157378.39) 43.61(29.71,59.75) 48198.01(37642.14,59080.37) 18.03(14.08,22.06) 779.94(525.35,1034.45) 0.29(0.19,0.38) 16115.44 (7048.84, 30627.88) 5.86(2.54,11.19) 312582.39(274094.58,353358.44) 119.82(105.23,135.28) High-middle SDI 57578.71(36776.02,82142.13) 22.29(14.28,31.76) 14783.76(10960.92,19144.78) 5.75(4.27,7.45) 716.50(518.86,902.32) 0.28(0.20,0.35) 9981.41 (3945.76, 19362.86) 3.94(1.56,7.64) 245096.95(215033.53,277759.99) 94.42(82.82,107.08) Middle SDI 91430.51(57280.85,131870.61) 27.16(17.08,39.11) 13882.30(17988.66,10277.04) 4.12(3.05,5.34) 1145.43(838.16,1423.81) 0.35(0.26,0.43) 9302.43 (3761.59, 18179.92) 2.91(1.21,5.65) 307528.58 (269305.69,347599.79) 90.03(78.77,101.85) Low-middle SDI 57585.59(37216.47,80821.32) 32.66(21.14,45.79) 14674.67(10890.52,19015.07) 8.40(6.24,10.89) 558.77(373.27,730.49) 0.33(0.22,0.43) 5362.32 (2047.08, 10696.99) 3.25(1.27,6.44) 117273.52(102820.19,132844.28) 65.59(57.46,74.35) Low SDI 12552.94(8057.84,17650.15) 21.42(13.79,30.05) 3628.43(2710.92,4686.33) 6.24(4.67,8.07) 161.68(99.83,223.88) 0.29(0.18,0.39) 1524.12 (559.63,3034.42) 2.79(1.04,5.57) 29070.78(25578.00,32941.07) 48.63(42.72,55.17) Andean Latin America 2329.41(1553.75,3241.21) 32.47(21.75,45.07) 202.84(146.85,267.46) 2.80(2.03,3.69) 29.01(22.62,33.87) 0.40(0.32,0.47) 133.11(51.43,255.18) 1.85(0.72,3.55) 8960.39(7529.88,10556.71) 122.86(103.20,144.81) Australasia 5044.05(3437.44,6936.90) 74.56(50.92,102.49) 2108.38(1608.64,2674.22) 30.58(23.31,38.75) 22.73(14.14,30.27) 0.33(0.20,0.44) 530.04(271.64,899.67) 7.49(3.81,12.75) 6948.29(5903.13,8036.61) 103.06(87.68,119.07) Caribbean 1264.54(917.77,1678.84) 18.84(13.66,25.03) 253.55(186.19,331.75) 3.79(2.78,4.95) 21.95(14.10,29.11) 0.33(0.21,0.43) 269.88(111.10,512.30) 3.99(1.64,7.58) 6729.46(5681.96,7889.55) 100.65(84.99,117.97) Central Asia 834.59(486.93,1255.62) 8.35(5.02,12.35) 899.73(654.06,1177.16) 8.76(6.40,11.50) 26.65(16.13,36.85) 0.26(0.16,0.37) 378.57(149.04,724.24) 3.81(1.51,7.37) 7812.04(6694.13,9091.76) 71.94(61.49,83.87) Central Europe 2942.73(1656.18,4527.87) 10.26(5.81,15.74) 2609.62(1946.74,3344.44) 8.78(6.55,11.25) 57.45(33.32,85.49) 0.19(0.11,0.29) 1286.95(523.79,2488.71) 4.30(1.74,8.33) 22866.47(20278.93,25587.01) 78.06(69.28,87.29) Central Latin America 10434.99(6653.09,14961.91) 33.98(21.81,48.51) 285.28(198.32,387.42) 0.91(0.63,1.24) 108.29(76.73,135.78) 0.35(0.25,0.44) 357.27(126.36,731.95) 1.16(0.41,2.38) 32056.63(27757.71,36742.90) 101.56(87.90,116.45) Central Sub-Saharan Africa 696.96(422.74,1012.62) 11.54(7.10,16.60) 201.70 (149.62, 261.44) 3.32(2.47,4.31) 12.20(6.87,18.91) 0.21(0.12,0.32) 161.28(63.16,311.75) 2.90(1.15,5.61) 3113.72(2634.20,3636.91) 49.31(41.59,57.80) East Asia 83426.76(51851.49,121574.68) 29.45(18.35,42.89) 6253.65(4642.58, 8104.34) 2.22(1.65,2.88) 940.15(698.36,1179.35) 0.34(0.25,0.42) 3409.13(1053.43,7589.26) 1.26(0.39,2.83) 268409.74(236866.86,301239.69) 93.79(82.68,105.40) Eastern Europe 1827.92(928.70,2995.15) 3.68(1.88,6.03) 3713.72 (2702.09,4879.91) 7.64(5.57,10.04) 33.06(20.91,48.62) 0.07(0.04,0.10) 2858.81(1060.52,5716.90) 5.94(2.21,11.95) 36683.52 (32264.05,41509.06) 74.27(65.31,84.06) Eastern Sub-Saharan Africa 2317.87(1446.42,3327.71) 12.43(7.84,17.71) 602.52(449.45,777.32) 3.18(2.37,4.11) 44.31(25.95,65.86) 0.24(0.14,0.35) 486.35(185.32,951.10) 2.73(1.05,5.33) 6573.96(5744.63,7461.86) 33.81(29.47,38.47) High-income Asia Pacific 19794.82(12503.98,28367.68) 38.47(24.59,54.76) 2142.28(1583.81, 2789.67) 3.92(2.89,5.09) 149.73(88.17,219.38) 0.26(0.15,0.38) 734.47(264.96,1528.55) 1.25(0.45,2.59) 43966.16(38402.48,49740.99) 82.56(72.24,93.25) High-income North America 42454.74(28757.19,57699.21) 48.39(32.84,65.77) 28053.91(22203.05,34129.47) 31.93(25.27,38.83) 217.96(142.48,301.94) 0.25(0.16,0.34) 7947.63(3463.37,15065.44) 8.99(3.90,17.08) 117202.63(104085.05,130841.75) 134.46(119.48,150.04) North Africa and Middle East 2734.82(1496.85,4261.20) 4.86(2.66,7.57) 2503.28(1811.96,3295.91) 4.66(3.38,6.14) 192.65(131.74,237.08) 0.37(0.25,0.45) 1721.92(656.53,3383.73) 3.37(1.29,6.63) 46850.49(40368.32,53956.60) 84.99(73.09,98.06) Oceania 24.44(13.71,37.42) 2.83(1.60,4.32) 10.11(7.28,13.51) 1.21(0.87,1.62) 2.11(1.37,3.02) 0.27(0.18,0.38) 18.56(7.31,35.65) 2.59(1.11,4.85) 703.50(603.96,811.99) 83.26(71.34,96.29) South Asia 90509.77(58081.91,127602.27) 49.11(31.50,69.26) 22073.94(16462.39,28519.73) 12.14(9.06,15.69) 548.82(346.89,746.88) 0.31(0.20,0.42) 5365.34(1962.33,10953.87) 3.07(1.12,6.29) 109453.72(96518.27,123353.72) 58.85(51.85,66.36) Southeast Asia 7058.91(4258.14,10307.37) 8.64(5.27,12.52) 790.05(573.37,1044.07) 0.96(0.70,1.27) 275.80 (204.26, 346.71) 0.36(0.27,0.44) 4001.02(1832.54,7249.70) 5.62(2.76,9.84) 87682.40(75997.00,100039.03) 105.81(91.55,120.93) Southern Latin America 1208.65(716.55,1822.75) 17.84(10.76,26.64) 816.37(578.03,1101.98) 7.31(5.17,9.85) 25.70(14.72,38.57) 0.23(0.13,0.34) 247.77(90.70,497.85) 2.20(0.80,4.43) 11711.23(9954.10,13726.86) 105.61(89.80,123.76) Tropical Latin America 1832.33(994.34,2916.73) 5.58(3.04,8.88) 1972.58(1463.43,2559.15) 6.08(4.51,7.89) 135.80(102.45,154.04) 0.42(0.32,0.48) 1896.34(771.92,3724.12) 5.93(2.42,11.64) 25848.56(22887.54,29148.33) 78.66(69.63,88.72) Western Europe 53188.41(36854.93,71806.54) 47.03(32.48,63.77) 18863.70(14444.78,23707.76) 16.50(12.63,20.68) 428.56(300.29,522.81) 0.37(0.25,0.45) 9350.63(4090.06,17554.17) 7.74(3.34,14.68) 154085.33(132998.57,176740.50) 141.33(122.31,161.74) Western Sub-Saharan Africa 1412.18(861.60,2052.43) 6.03(3.67,8.76) 640.05(475.04,827.61) 2.91(2.16,3.78) 70.32(45.18,93.03) 0.33(0.21,0.43) 746.02(274.15,1479.52) 3.59(1.34,7.15) 11637.57(10210.79,13162.87) 50.84(44.53,57.59) RA rheumatoid arthritis, IBD inflammatory bowel disease, MS multiple sclerosis, T1DM type 1 diabetes mellitus, ASIR age-standardized incidence rate.

Regional incidence and ASIR of the 5 autoimmune diseases in 2021.

RA rheumatoid arthritis, IBD inflammatory bowel disease, MS multiple sclerosis, T1DM type 1 diabetes mellitus, ASIR age-standardized incidence rate.

Based on ASRs, Australasia had the highest ASIR, ASPR, and ASDR for RA, while Central Latin America recorded the highest ASMR for RA. High-income North America showed the highest ASIR, ASPR, and ASDR for IBD, whereas Western Europe had the highest ASMR. Tropical Latin America exhibited the highest ASIR for MS, while North America had the highest ASPR, ASMR, and ASDR for the disease. Western Europe demonstrated the highest psoriasis burden across all age-standardized measures.

At the national level, India and China bore the highest absolute burden of RA and IBD. Ireland, New Zealand, Canada, and the Netherlands exhibited the highest ASRs for IBD. Sweden, the United Kingdom, and Finland ranked highest for MS and T1DM burden. Haiti had the highest ASMR and ASDR for T1DM. For psoriasis, Germany reported the highest burden across all age-standardized metrics.

Burden of 5 autoimmune diseases by SDI

In 2021, individuals aged ≥60 years in the high SDI quintile exhibited higher incidence and prevalence for RA, IBD, T1DM and psoriasis. Conversely, the middle SDI quintile showed a higher incidence of MS, although prevalence was greater in the high SDI quintile ( Tables 2 , S1–S3). Mortality for IBD and MS were higher in the high SDI quintile, whereas RA and T1DM mortality were elevated in the middle SDI quintile (Table S2). Regarding DALYs, the high SDI quintile demonstrated greater burden for all five ADs among older adults (Table S3).

ASIR for RA, IBD, MS, T1DM and psoriasis were generally positively correlated with SDI among individuals aged ≥60 years, though periods of plateau or negative correlation were also observed (Fig. S3). At the national level, similar patterns between ASIR and SDI were found across 204 countries and territories (Fig. S4). The relationship between ASMR and ASDR with SDI for IBD, MS, and psoriasis mirrored those observed for ASIR. In contrast, T1DM exhibited a negative correlation with SDI at higher levels of SDI, and RA showed a negative correlation between ASMR and SDI in higher SDI levels (Figs. S5, S6). These patterns were consistently observed across 204 countries and territories (Figs. S7, S8).

Burden of 5 autoimmune diseases by sex and age

From 1990 to 2021, females aged ≥60 years had significantly higher incidence, prevalence, mortality, and DALYs for RA compared with males ( Figs. 3 A, S9A, S10A, S11A). For MS, incidence showed minimal sex differences; however, females in this age group consistently exhibited higher prevalence, mortality, and DALYs than males ( Figs. 3 C, S9C, S10C, S11C). In T1DM, females were more affected than males between 1990 to 2000, but sex-based disparities in incidence, mortality, and DALYs gradually diminished after 2000 ( Figs. 3 D, S9D, S10D, S11D). For psoriasis, no significant sex difference was observed in incidence among older adults, although males had slightly higher prevalence and DALYs ( Figs. 3 E, S9E, S11E).

Global number of incident cases and ASIRs of rheumatoid arthritis(A), inflammatory bowel disease(B), multiple sclerosis(C), type 1 diabetes mellitus(D), and psoriasis(E) by age and sex,1990-2021. ASIR , age-standardized incidence rate.

Among individuals aged ≥60 years, both DALYs and mortality rates for RA and IBD increase with advancing age, with a particularly steep rise observed for IBD despite a gradual decline in its incidence (Table S4, Figs. S12, S13B). Across all age groups over 60, RA-related DALYs and mortality remain consistently higher in females than in males, whereas IBD shows no significant sex differences until after age 95 (Figs. S12, S15A, S15B, S16A, S16B). By contrast, age-related increases in DALYs and mortality are relatively modest for the other three ADs. The incidence and prevalence of RA and psoriasis generally rise with age, peaking at approximately 70 years before declining thereafter (Figs. S12, S13A, S13E, S17A, S17E). For T1DM, incidence, prevalence, mortality, and DALYs all steadily increase with age among individuals aged ≥60 years (Figs. S12, S13D, S15D, S16D, S17D).

From Fig. S14, psoriasis and RA consistently show markedly higher ASIR and ASPR than the other three ADs across all age groups aged ≥60 years. In contrast, while RA maintain relatively high ASDR and ASMR, IBD displays a pronounced increase in both measures advancing age. Across these age groups, women generally have ASDRs comparable to or exceeding those of men (Fig. S14D). Notably, after age 85, women exhibit significantly higher ASIR and ASPR than men, and their ASMR surpasses that of men in the 95+ age group (Fig. S14A–C).

Decomposition analysis

Fig.4 shows the decomposition analysis of factors influencing the incidence of five ADs in individuals aged ≥60 years, stratified by SDI from 1990 to 2021. Population growth consistently acts as a promoting factor for all five ADs. Demographically adjusted epidemiology changes also promote the incidence of RA, IBD, T1DM, and psoriasis, but mitigate that of MS, with the mitigating effect strengthening as SDI increases. Aging promotes the incidence of RA and T1DM, while mitigating that of IBD and psoriasis. For all factors—whether promoting or mitigating—the magnitude of their influence increases with higher SDI levels.

Decomposition analysis of factors contributing to incident cases of rheumatoid arthritis(A), inflammatory bowel disease(B), multiple sclerosis(C), type 1 diabetes mellitus(D), and psoriasis(E), stratified by SDI, 1990-2021. SDI, Socio-Demographic Index .

In Fig. S18, population growth remains a promoting factor for DALYs across all five ADs in individuals aged ≥60 years, with strongest effects observed in high SDI regions for IBD and MS, and in medium SDI regions for RA and T1DM. Globally, demographically adjusted epidemiological changes mitigate DALYs for most ADs, except for MS, where they act as a promoting factor. Aging increases DALYs, with the greatest impact for IBD, particularly in high SDI regions. The patterns of influence for populations, demographically adjusted epidemiological changes, and aging on mortality closely mirror those observed for DALYs (Fig. S19).

Predictions of global trends in five autoimmune diseases among older adults through 2035

Using the BAPC model, we projected ASIR, incidence, ASPR, prevalence, ASMR, mortality, DALYs, and ASDR for five ADs in the global population aged ≥60 years through 2035, based on GBD 2021 estimates. The projections indicate that RA, IBD, MS, and psoriasis will show gradual increases in ASIR, incidence, ASPR, and prevalence. Psoriasis is expected to experience a rise in ASDR, whereas ASDR for RA, IBD, and MS is projected to decline (Fig. S20). For MS, both ASIR and ASPR are expected to plateau, while ASDR decreases ( Figs. 5 , S20, S21). Mortality numbers for all ADs except psoriasis are anticipated to rise slowly, though ASMR is predicted to decline (Fig. S22). Notably, the decline in ASDR for RA is more pronounced in females, whereas the increase in ASDR for T1DM is greater in males, suggesting a narrowing of the global burden gap between sexes (Fig. S20).

Projections of global incident cases and ASIR of rheumatoid arthritis(A), inflammatory bowel disease(B), multiple sclerosis(C), type 1 diabetes mellitus(D), and psoriasis(E) through 2035. ASIR , age-standardized incidence rate.

Discussion

Using data from GBD 2021, this study provides the first comprehensive assessment of the burden of five major ADs—RA, IBD, MS, T1DM, and psoriasis—specifically among adults aged 60 years and older, a population that has often been overlooked in previous autoimmune research. We examined incidence, prevalence, mortality, DALYs, and temporal trends across regions, countries, sexes, and SDI. Our findings reveal marked disparities in the distribution and trajectories of these diseases, reflecting the combined effects of demographic transitions, epidemiologic transitions, healthcare capacity, and environmental exposures.

In 2021, psoriasis and RA were the leading contributors to ADs burden in older adults, with psoriasis showing especially high prevalence. These findings are consistent with prior evidence identifying psoriasis as one of the most common chronic immune-mediated conditions worldwide [ 17 ]. The rising prevalence of RA and T1DM, together with declining mortality in both, suggests that advances in treatment—such as biologics, disease-modifying anti-rheumatic drugs, and optimized insulin regimens—have extended survival but left a persistent morbidity burden [ 10 , 18 ]. In contrast, MS showed declining incidence but increasing mortality and DALYs, underscoring the long-term disabling nature of the disease and the challenges of management later in life. This divergence between incidence and outcomes indicates that MS may disproportionately contribute to disability among older adults even as fewer new cases occur [ 19 ].

Striking regional disparities in ASIR, ASPR, ASMR, and ASDR were observed, with the highest rates concentrated in high-SDI regions such as North America, Australasia, and Western Europe. Health equity analysis confirmed that high-SDI countries shoulder a disproportionate share of the burden among older adults, consistent with prior findings across all age groups [ 20 ]. This pattern likely reflects a combination of more complete case ascertainment, greater exposure to environmental triggers in genetically susceptible populations, industrialization-related pollutants, and Westernized dietary habits, particularly implicated in IBD pathogenesis [ 21 , 22 ]. In contrast, lower-SDI regions may experience underdiagnosis and underreporting, producing an apparently lower burden despite increasing incidence. Meanwhile, populous countries such as China and India carry large absolute burdens even where ASRs are only moderate, emphasizing the need to consider both relative and absolute measures when evaluating disease burden.

Unlike most aging studies that focus on non-communicable diseases such as cardiovascular conditions, cancer, or dementia, ADs are not typically regarded as age-related. Nonetheless, our findings show that ADs contribute substantially to morbidity and mortality in older adults, highlighting a neglected dimension of aging research. Moreover, while recent studies have primarily emphasized short-term infection risks and immune dysregulation in the context of COVID-19 [ 23 ], our work complements these efforts by providing a long-term perspective on the global and regional burden of ADs in aging populations.

The positive correlation between higher SDI and incidence or prevalence for several diseases underscores the double-edged nature of development. As socioeconomic conditions improve, populations face rising exposure to environmental and lifestyle factors that increase autoimmune risk, while at the same time benefiting from stronger healthcare systems that reduce mortality and DALYs. This duality is most evident for RA and T1DM, which showed rising incidence but declining mortality. In contrast, IBD exhibited only modest increases, while psoriasis continued to expand steadily, likely reflecting interplay of environmental, immunity, and aging factors. These results suggest that developing countries undergoing rapid industrialization may face a growing autoimmune burden unless proactive measures, such as stricter environmental regulation and healthier dietary practices, are prioritized.

Sex differences were also apparent. RA and MS showed higher burdens among older women, consistent with well-established disparities earlier in life that persist into later years. While sex hormones such as estrogen and progesterone have traditionally been implicated, their influence wanes after menopause, indicating that other mechanisms sustain these differences in older age [ 24 ]. By contrast, psoriasis was slightly more common in older men, likely reflecting environmental factors such as smoking, alcohol use, and occupational exposures rather than intrinsic susceptibility [ 25 ]. For T1DM, the earlier female predominance diminished after 2000, suggesting progress toward greater gender equity in diagnosis and treatment. Overall, these findings indicate that sex-related differences in autoimmune burden among older adults extend beyond hormonal influences and are shaped by both environmental exposures and biological mechanisms [ 26 ].

Age-related patterns further contextualize disease burden. DALYs and mortality from RA and IBD rose steeply with advancing age, underscoring their heavy toll among the oldest-old. Although IBD incidence declined with age, the disproportionate rise in mortality and DALYs suggests that older patients may experience more severe disease progression, complications, or limited access to advanced treatments. For RA and psoriasis, incidence and prevalence peaked around age 70 before declining, which may reflect survivor bias or lower diagnostic activity in advanced age. In contrast, T1DM showed steadily rising incidence and DALYs across older age groups, highlighting the ongoing clinical and public health challenge of managing long-standing metabolic and ADs in aging populations.

Decomposition analyses further clarified the drivers of these patterns. Population growth consistently fueled increases in incidence and DALYs for all five diseases, particularly magnifying the absolute burdens in South and East Asia. Aging also played a major role, especially in increasing the incidence and DALYs of RA and T1DM, while mitigating IBD and psoriasis. Improvements in epidemiologic surveillance and treatment contributed to declining mortality and DALYs for most diseases, demonstrating the impact of stronger healthcare systems. These findings highlight how demographic and epidemiologic transitions interact to shape the evolving burden of ADs in older adults.

Projections to 2035 indicate continued increases in the incidence and prevalence of RA, IBD, psoriasis, and to a lesser degree MS, with psoriasis also showing a projected rise in DALYs. Mortality and DALYs are expected to decline for several conditions, particularly RA and IBD, underscoring the potential of improved management to reduce severity even as incidence rises. Notably, narrowing sex differences in T1DM suggest that global efforts to improve gender equity in healthcare delivery are beginning to yield benefits. These forecasts highlight the importance of prevention and sustained management strategies specifically tailored to older populations.

This study has several limitations. First, GBD estimates are limited by data gaps and variability in data quality, particularly in low-resource settings. Incomplete or inaccurate reporting—such as underdiagnosis or misclassification of ADs—can lead to biased estimates. In regions lacking robust surveillance, the models rely heavily on extrapolated data, which may reduce the reliability of the reported disease burden. Second, the GBD database includes only a limited number of autoimmune diseases, such as RA, IBD, MS, T1DM, and psoriasis, which may constrain comprehensive analysis. The omission of other relevant autoimmune conditions, including systemic lupus erythematosus, Sjögren's syndrome, and particularly polymyalgia rheumatica, may lead to an underestimation of the overall disease burden, especially among older adults. Third, disparities in healthcare infrastructure and diagnostic capacity across regions may impact data comparability. Regions with more advanced surveillance and reporting systems, typically those with a high-SDI, are likely to achieve more accurate case detection, potentially resulting in apparently higher disease burdens compared to regions affected by underdiagnosis or incomplete reporting. Consequently, the observed regional differences may partially reflect variations in case ascertainment rather than true differences in disease burden. Therefore, future research integrating GBD data with clinical and molecular evidence is warranted to achieve a deeper mechanistic understanding of autoimmune disease burden and progression.

In conclusion, our analysis demonstrates substantial regional, demographic, and socioeconomic disparities in the burden of ADs among older adults. High-SDI regions experience greater overall burden but also improved survival, while developing countries are likely to face rising challenges as they undergo rapid socioeconomic transitions. Persistent sex differences point to multifactorial etiologies that extend beyond hormonal influences. Population growth, aging, and epidemiologic transitions remain the main drivers of burden, with future projections indicating continued increases for several diseases.

Collectively, these findings underscore the urgent need for targeted, equitable, and age-specific prevention and management strategies. By demonstrating the substantial and rising burden of ADs among older adults, our study adds a critical dimension to aging research and provides evidence to guide health policy and resource allocation in the context of global population aging.

CRediT authorship contribution statement

(I) Conception and design: Suqi Zeng, Junhai Zhen, Yu Pu; (II) Administrative support: Weiguo Dong, Xiaoli Wang, Junjie Chen; (III) Provision of study materials or patients: Suqi Zeng, Yu Pu, Junhai Zhen, Chuan Liu; (IV) Collection and assembly of data: Suqi Zeng, Chuan Liu, Jiaming Hu; (V) Data analysis and interpretation: Suqi Zeng, Chuan Liu, Jiaming Hu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Ethical statement

This research is based on data from the Global Burden of Disease (GBD) study, which is publicly accessible and de-identified, and does not involve direct interaction with human participants or require ethical approval.

Data availability statement

The data used in this study can be derived from the GBD 2021 (Available at: https://ghdx.healthdata.org/gbd-2021 ).

Declaration of competing interest

The authors have no relevant financial or non-financial interests to disclose.

Footnotes

Supplementary material related to this article can be found, in the online version, at doi: https://doi.org/10.1016/j.jnha.2025.100681 .

Contributor Information

Jun-Jie Chen, Email: jay252979@163.com.

Xiao-Li Wang, Email: wangxiaoli@whu.edu.cn.

Wei-Guo Dong, Email: dongweiguo@whu.edu.cn.

Supplementary data

The following are Supplementary data to this article:

Fig. S1

Maps showing ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), and type 1 diabetes mellitus (D) across countries in 2021. ASMR , age-standardized mortality rate.

Fig. S2

Maps showing ASDRs of arthritis (A), inflammatory bowel disease (B), multiple sclerosis(C), type 1 diabetes mellitus(D), and psoriasis (E) across countries in 2021. ASDR , age-standardized disability-adjusted life-years rate.

Fig. S3

ASIRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis(E) across regions among individuals aged ≥60 years, stratified by SDI in 2021. ASIR , age-standardized incidence rate.

Fig. S4

ASIRs of rheumsatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) across 204 countries and territories among individuals aged ≥60 years, stratified by Socio-Demographic Index. ASIR , age-standardized incidence rate.

Fig. S5

ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), and type 1 diabetes mellitus (D) across regions among individuals aged ≥60 years, stratified by Socio-Demographic Index. ASMR , age-standardized mortality rate.

Fig. S6

ASDRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D) and psoriasis (E) across regions among individuals aged ≥60 years, stratified by Socio-Demographic Index. ASDR , age-standardized disability-adjusted life-years rate.

Fig. S7

ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), and type 1 diabetes mellitus (D) across 204 countries and territories among individuals aged ≥60 years, stratified by Socio-Demographic Index. ASMR , age-standardized mortality rate.

Fig. S8

ASDRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D) and psoriasis (E) across 204 countries and territories among individual aged ≥60 years, stratified by SDI. ASDR , age-standardized disability-adjusted life-years rate; SDI , Socio-Demographic Index.

Fig. S9

Global number of prevalent cases and ASPRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) by age and sex, 1990–2021. ASPR, age-standardized prevalence rate.

Fig. S10

Global number of deaths and ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), and type 1 diabetes mellitus (D) by age and sex, 1990–2021. ASMR, age-standardized mortality rate.

Fig. S11

Global number of DALYs and ASDRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) by age and sex,1990–2021. DALYs, disability-adjusted life years; ASDR, age-standardized disability-adjusted life-years rate.

Fig. S12

Age and sex distribution of global incidence (A), prevalence (B), mortality (C) and disability-adjusted life-years rate (D) of rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, type 1 diabetes mellitus, and psoriasis among individuals aged ≥60 years in 2021.

Fig. S13

Age-specific incidence rates of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) among individuals aged ≥60 years by sex, 2021.

Fig. S14

Age-specific global incidence (A), prevalence (B), mortality (C), and DALY rates (D) of five autoimmune diseases among individuals aged ≥60 years in 2021.

Fig. S15

Age-specific DALY rates of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis(E) among individuals aged ≥60 years by sex in 2021. DALY, disability-adjusted life years.

Fig. S16

Age-specific mortality rates of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C) and type 1 diabetes mellitus (D) by sex, 2021.

Fig. S17

Age-specific prevalence rates of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) by sex, 2021.

Fig. S18

Decomposition analysis of factors contributing to DALYs for rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D) and psoriasis (E) stratified by SDI from 1990 to 2021. DALY, disability-adjusted life years; SDI, Socio-Demographic Index.

Fig. S19

Decomposition analysis of factors contributing to mortality for rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C) and type 1 diabetes mellitus (D) stratified by SDI from 1990 to 2021. SDI, Socio-Demographic Index.

Fig. S20

Projections of global DALYs and ASDRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) through 2035. DALY, disability-adjusted life years; ASDR, age-standardized disability-adjusted life-years rate.

Fig. S21

Projections of global prevalent cases and ASPRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis(C), type 1 diabetes mellitus (D), and psoriasis (E) through 2035. ASPR, age-standardized prevalence rate.

Fig. S22

Projections of global deaths and ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C) and type 1 diabetes mellitus (D) through 2035. ASMR , age-standardized mortality rate.

References

Associated Data

Supplementary Materials

Fig. S1

Maps showing ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), and type 1 diabetes mellitus (D) across countries in 2021. ASMR , age-standardized mortality rate.

Fig. S2

Maps showing ASDRs of arthritis (A), inflammatory bowel disease (B), multiple sclerosis(C), type 1 diabetes mellitus(D), and psoriasis (E) across countries in 2021. ASDR , age-standardized disability-adjusted life-years rate.

Fig. S3

ASIRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis(E) across regions among individuals aged ≥60 years, stratified by SDI in 2021. ASIR , age-standardized incidence rate.

Fig. S4

ASIRs of rheumsatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) across 204 countries and territories among individuals aged ≥60 years, stratified by Socio-Demographic Index. ASIR , age-standardized incidence rate.

Fig. S5

ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), and type 1 diabetes mellitus (D) across regions among individuals aged ≥60 years, stratified by Socio-Demographic Index. ASMR , age-standardized mortality rate.

Fig. S6

ASDRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D) and psoriasis (E) across regions among individuals aged ≥60 years, stratified by Socio-Demographic Index. ASDR , age-standardized disability-adjusted life-years rate.

Fig. S7

ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), and type 1 diabetes mellitus (D) across 204 countries and territories among individuals aged ≥60 years, stratified by Socio-Demographic Index. ASMR , age-standardized mortality rate.

Fig. S8

ASDRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D) and psoriasis (E) across 204 countries and territories among individual aged ≥60 years, stratified by SDI. ASDR , age-standardized disability-adjusted life-years rate; SDI , Socio-Demographic Index.

Fig. S9

Global number of prevalent cases and ASPRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) by age and sex, 1990–2021. ASPR, age-standardized prevalence rate.

Fig. S10

Global number of deaths and ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), and type 1 diabetes mellitus (D) by age and sex, 1990–2021. ASMR, age-standardized mortality rate.

Fig. S11

Global number of DALYs and ASDRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) by age and sex,1990–2021. DALYs, disability-adjusted life years; ASDR, age-standardized disability-adjusted life-years rate.

Fig. S12

Age and sex distribution of global incidence (A), prevalence (B), mortality (C) and disability-adjusted life-years rate (D) of rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, type 1 diabetes mellitus, and psoriasis among individuals aged ≥60 years in 2021.

Fig. S13

Age-specific incidence rates of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) among individuals aged ≥60 years by sex, 2021.

Fig. S14

Age-specific global incidence (A), prevalence (B), mortality (C), and DALY rates (D) of five autoimmune diseases among individuals aged ≥60 years in 2021.

Fig. S15

Age-specific DALY rates of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis(E) among individuals aged ≥60 years by sex in 2021. DALY, disability-adjusted life years.

Fig. S16

Age-specific mortality rates of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C) and type 1 diabetes mellitus (D) by sex, 2021.

Fig. S17

Age-specific prevalence rates of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) by sex, 2021.

Fig. S18

Decomposition analysis of factors contributing to DALYs for rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D) and psoriasis (E) stratified by SDI from 1990 to 2021. DALY, disability-adjusted life years; SDI, Socio-Demographic Index.

Fig. S19

Decomposition analysis of factors contributing to mortality for rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C) and type 1 diabetes mellitus (D) stratified by SDI from 1990 to 2021. SDI, Socio-Demographic Index.

Fig. S20

Projections of global DALYs and ASDRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C), type 1 diabetes mellitus (D), and psoriasis (E) through 2035. DALY, disability-adjusted life years; ASDR, age-standardized disability-adjusted life-years rate.

Fig. S21

Projections of global prevalent cases and ASPRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis(C), type 1 diabetes mellitus (D), and psoriasis (E) through 2035. ASPR, age-standardized prevalence rate.

Fig. S22

Projections of global deaths and ASMRs of rheumatoid arthritis (A), inflammatory bowel disease (B), multiple sclerosis (C) and type 1 diabetes mellitus (D) through 2035. ASMR , age-standardized mortality rate.

Data Availability Statement

The data used in this study can be derived from the GBD 2021 (Available at: https://ghdx.healthdata.org/gbd-2021 ).