Association between childhood tonsillectomy and increased risk of autoimmune disease: a nationwide population-based cohort study.

OBJECTIVES

Tonsils and adenoids play crucial roles in the immune system, particularly during early childhood. This study investigated the association between childhood tonsillectomy and/or adenoidectomy and the subsequent development of autoimmune disease.

METHODS

Using nationwide claims data from the Health Insurance Review and Assessment Service, we identified children aged 0-12 years who received medical care for tonsillar or adenoid disease between January 2007 and January 2008. Participants were classified into surgery (tonsillectomy or adenoidectomy between 2007 and 2013) and non-surgery groups and followed until autoimmune disease diagnosis or June 2023. A Cox proportional hazards model was used to analyze the risk of developing autoimmune disease according to surgery.

RESULTS

A total of 84,030 children in the surgery group and 336,120 age- and sex-matched children in the non-surgery group were analyzed, with a mean follow-up duration of 15.56 years. The incidence rates of autoimmune diseases in the non-surgery and surgery groups were 65.3 and 86.5 per 100,000 person-years, respectively. Surgery (vs. non-surgery) was associated with an increased risk of developing systemic lupus erythematosus [hazard ratio (HR) 2.20, 95% confidence interval (CI) 1.55-3.13], ankylosing spondylitis (HR 1.35, 95% CI 1.06-1.72), juvenile idiopathic arthritis (HR 1.69, 95% CI 1.19-2.39), type 1 diabetes (HR 1.34, 95% CI 1.14-1.58), Hashimoto's thyroiditis (HR 1.39, 95% CI 1.22-1.57), and Graves' disease (HR 1.38, 95% CI 1.22-1.56). Overall, surgery was associated with an increased risk of developing autoimmune disease (HR 1.32, 95% CI 1.23-1.41).

CONCLUSION

Tonsillectomy and/or adenoidectomy during childhood was associated with an increased risk of developing autoimmune diseases later in life. These findings suggest a possible association between tonsillar and adenoid immune function and later autoimmune disease risk.