Methods
Results
Reference | Diagnosis | Data source | Study population | Diagnosis definition | Investigation period | Prevalence, raw data | Prevalence in women/men | Standardization |
---|---|---|---|---|---|---|---|---|
Schmidt 2020 [4] | RA AS SLE Sjögren | Nationwide NAKO health study | 101,779 responders (20–69 years) | Patient-reported medical diagnosis (ever) | 2014–2017 (prevalence estimated from age- and sex-stratified random sample; one-time survey during the period) | RA: 1.85% AS: 0.49% SLE: 0.14% Sjögren: 0.07% | RA: 2.62%/1.08% AS: 0.42%/0.55% SLE: | Age and gender standardized to German standard population 2011 |
Kienitz 2020 [5] | RA | Nationwide SHI claims data | Approx. 2.3 million insured persons ≥ 18 years | (1) ICD: M05, M06; (2) Specialist diagnosis (3) ICD code + DMARD | 2008–2013 2013 (annual prevalence in the respective annual cross section) | (1) 2008–2013: 1.17–1.34% (2) 2011–2013: 0.94–1.07% (3) 2008–2013: 0.44–0.54% | (1) 1.8%/0.8% (2013) | No standardization |
Grellmann 2020 [6] | RA PsA | Nationwide SHI claims data | 965,759–1930,158 (different in the years considered) ≥ 18 years | RA: M05.8, M06.0, M06.8 PsA: M07.0–3, L40.5 | 2012–2016 (annual prevalence in the respective annual cross section) | RA: 0.42–0.53% (2012–2016) PsA: 0.27–0.32% | Women of childbearing age: RA: 0.2% PsA: 0.1–0.2% | Age- and gender-standardized to the total SHI population in the respective year |
Beam 2018 [7] | RA | Regional AOK claims data | 3,446,670 insured persons | (1) ICD: M05, M06 (2) + Medication | 2013 | (1) 1.05% (2) 0.64% | (1): 1.4%/0.64% (2) 0.86%/0.39% | Age-standardized to “old” European standard population of 1976 |
Steffen 2017 [8] | RA | Nationwide SHI claims data | 60–61 million insured persons | (1) M05, M06 + laboratory (2) 2014: at least 1 × ICD-code + laboratory in the entire period | 2009–2015 (annual prevalence in the respective annual cross section) | (1) 2009: 0.87% (0.87%) (1) 2015: 1.08% (1.06%) (2) 2014: 1.23% (1.20%) | 1.49%/0.62% (2015) | Age- and gender-standardized to SHI total population 2016 |
Hense 2016 [9] | RA | Nationwide BARMER claims data | 7,155,315 insured persons | (1) M05, M06 (2) + Laboratory (3) + Medication (4) + Rheumatology | 2013 (annual prevalence) | (1) 1.62% (1.38%) (2) 1.11% (0.95%) (3) 0.94% (0.81%) (4) 0.64% (0.55%) | – | Age and gender standardized to German standard population 2013 |
Krüger 2018 [10] | AS | Nationwide SHI claims data (InGef) | 3.2 million insured persons | M45 | 2013 (annual prevalence) | 322/100,000 | – | Database representative of German population by gender and age, therefore no separate standardization |
PsA | Nationwide SHI claims data | 64–65 million insured persons | Not specified | 2009–2012 (annual prevalence in the respective annual cross section) | 2009: 0.20% 2012: 0.24% | 0.21–0.25%/ 0.18–0.21% | No standardization for total estimators | |
Reinhardt 2021 [13] | PsA Juvenile PsA | DAK claims data | 2,319,584 insured persons | M07.0–3, M09.0 (juvenile) | 2010 (annual prevalence) | 0.31% (0.29%) Juvenile: 0.01% (0.01%) | – | Age- and gender-standardized to SHI total population 2012 |
Sondermann 2018 [14] | PsA | Regional AOK claims data | Approx. 2.8 million insured persons | L40.5 | 2014 (quarters 1 and 2) | 0.11% | – | No standardization |
Rech 2020 [15] | PsA | Nationwide claims data (InGef) | 2.9 million adult insured persons | M07.0, M07.1, M07.3 | 2012–2017 (cumulated) | 2017: 0.15% | – | Database assumed to be representative of German population by gender and age, therefore no separate standardization |
Schwarting 2021 [16] | SLE | Nationwide BKK claims data | 4.1 million adult insured persons | M32.1,8,9 + Laboratory/medication/specialist diagnosis | 2009–2014 (annual prevalence in the respective annual cross section) | 2009: 37.3 (38.6)/100,000 2014: 47.4 (48.5)/100,000 with statistical adjustment for right-censored data in 2014: 55.8/100,000 | 2014: 79.8/13.8 per 100,000 | – |
Brinks 2014 [17] | SLE | Nationwide SHI claims data | 2.3 million insured persons | M32 | 2002 (annual prevalence) | 36.7 [34.3–39.3]/100,000 | 55.4/15.4 per 100,000 | No standardization |
Albrecht 2020 [18] | Sjögren | Nationwide BARMER claims data | 7.2 million insured persons ≥ 18 years | M35.0 | 2007–2018 (annual prevalence in the respective annual cross section) | 2007–2018: 0.68–0.77% | 0.87–0.97%/0.38–0.44% per 100,000 | No standardization |
Colombo 2022 [19] | PMR | Regional AOK claims data | Not specified ≥ 40 years | M35.3, M31.5 | 2011–2019 (annual prevalence in the respective annual cross section and cumulative) | 2011:115(107)/100,000 2019: 153(145)/100,000 Cumulated: 139(130)/100,000 | 166/86 per 100,000 (cumulative, age standardized) | Age- and gender-standardized to total SHI population 2019 |
Herlyn 2014 [20] | GCA AAV | Regional survey | 469,000 inhabitants | GCA: M31.5, M31.6 GPA: M31.3, EGPA: M30.3, MPA: M31.7 + CHCC definition, ACR criteria | 2006 (annual prevalence) | GCA: 440 [399;481]/1 mio ≥ 50 years AAV: 149 [126;174]/1 mio GPA: 98 [79;117], MPA: 28 [18;117], EGPA: 24 [14;35] | GCA: 612/219 AAV: 271/328 per 1 m ≥ 50 years | No standardization on standard population |
Hellmich 2021 [21] | AAV | Nationwide SHI claims data (InGef) | Approx. 3 million insured persons ≥ 18 years | M31.3 (GPA), M31.7 (MPA) | 2013–2016 (cumulated) | AAV: 256 ± 11/1 mio GPA: 210 ± 7/1 mio MPA: 46 ± 4/1 mio | – | Database assumed to be representative of German population by gender and age, therefore no separate standardization |
Thomschke 2018 [22] | JIA | Nationwide SHI claims data | Approx. 12 million insured persons 0–19 years | M08.–, M09.0 (L40.5) | 2009–2015 (annual prevalence in the respective annual cross section) | 2009: 73.4/100,000 until 2015: 101.5/100,000 | 119.8/58.9 per 100,000 (average annual prevalence) | No standardization |
Luque Ramos 2017 [23] | JIA | Nationwide BARMER claims data | 238,000 insured persons 16–18 years | M08.x, M09.0 | 2008–2010 | 2008: 0.11% 2009, 2010: 0.13% | – | No standardization |
Assessment of the risk of bias
External validity 1 Was the target population of the study a good representation of the national population in terms of the relevant variables? 2 Was the sampling frame a true or accurate representation of the target population? 3 Was a form of random selection used to select the sample OR was a census conducted? 4 Was the probability of non-response bias minimal? Internal validity 5 Were the data collected directly from the subjects (as opposed to a proxy)? 6 Did the study use an acceptable case definition? 7 Was the study instrument used to measure the parameter of interest valid and reliable? 8 Was the same type of data collection used for all subjects? 9 Was the length of the shortest prevalence period appropriate for the parameter of interest? 10 Were the numerator(s) and denominator(s) appropriate for the parameter of interest? 11 Summary item on overall risk of study bias | |||||||||||
– | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 (overall assessment) |
Schmidt [4] | Low | Low | Low | High | Low | Low | High | Low | Low | Low | Moderate |
Kienitz [5] | Low | Low | Low | Low | n.a. | Low | High | Low | Low | Low | Moderate |
Grellmann [6] | Low | Low | Low | Low | n.a. | High | High | Low | Low | Low | Moderate |
Beam [7] | High | High | Low | Low | n.a. | Low | High | Low | Low | Low | High |
Steffen [8] | Low | Low | Low | Low | n.a. | Low | High | Low | Low | Low | Moderate |
Hense [9] | High | Low | Low | Low | n.a. | Low | High | Low | Low | Low | Moderate |
Krüger [10] | Low | Low | Low | Low | n.a. | Low | High | Low | Low | Low | Moderate |
Deike [11] | Low | Low | Low | Low | n.a. | High | High | Low | Low | Low | Moderate |
Sewerin [12] | Low | Low | Low | Low | n.a. | High | High | Low | Low | Low | Moderate |
Reinhardt [13] | High | High | Low | Low | n.a. | High | High | Low | High | High | High |
Sondermann [14] | High | High | Low | Low | n.a. | High | High | Low | Low | Low | High |
Rech [15] | Low | Low | Low | Low | n.a. | High | High | Low | Low | Low | Moderate |
Schwarting [16] | High | Low | Low | Low | n.a. | Low | High | Low | Low | Low | Moderate |
Brinks [17] | Low | Low | Low | Low | n.a. | High | High | Low | Low | Low | Moderate |
Albrecht [18] | High | Low | Low | Low | n.a. | High | High | Low | Low | Low | High |
Colombo [19] | High | Low | Low | Low | n.a. | High | High | Low | Low | Low | High |
Herlyn [20] | High | High | High | High | Low | Low | Low | High | Low | Low | High |
Hellmich [21] | Low | Low | Low | Low | n.a. | Low | High | Low | Low | Low | Moderate |
Thomschke [22] | Low | Low | Low | Low | n.a. | High | High | Low | Low | Low | Moderate |
Luque Ramos [23] | High | Low | Low | Low | n.a. | High | High | Low | Low | Low | High |
Study results on prevalence and classification
Rheumatoid arthritis
Prevalence data (%) from the studies | Prevalence assumption (%) after analysis of the studies | Estimated number of people affecteda | Accuracy of the estimate from the authors’ point of view | |
---|---|---|---|---|
Rheumatoid arthritis | 0.42–1.85 | 0.8–1.2 | 560,000–830,000 | Moderate |
Spondyloarthritis (All) | 1.0–1.4f | 1.0–1.4 | 690,000–970,000 | Low |
Ankylosing spondylitis | 0.32–0.5 | 0.5 | 350,000 | Low |
Psoriatic arthritis | 0.11–0.32 | 0.24–0.32 | 170,000–220,000 | Moderate |
Systemic lupus erythematosus | 0.037–0.14 | 0.056 | 39,000 | Moderate |
Sjögren’s (sicca syndrome) Of which primary Sjögren’s disease | 0.07–0.77 | 0.4–0.7 0.07 | 280,000–490,000 49,000 | Low |
Systemic sclerosis | 0.017–0.025f | 0.017–0.025 | 12,000–17,000 | Low |
Idiopathic inflammatory myopathies | 0.0024–0.034f | 0.012–0.017 (adults + children) | 10,000–14,000b | Low |
Total connective tissue diseasesg | – | 0.16–0.17 | 111,000–118,000 | Low |
Polymyalgia rheumatica | 0.14–0.15 (≥ 40 years) | 0.14–0.15 (≥ 40 years) | 66,000–71,000c | Low |
Giant cell arteritis | 0.04–0.05 (≥ 50 years) | 0.04–0.05 (≥ 50 years) | 15,000–19,000d | Low |
ANCA-associated vasculitides | 0.015–0.026 | 0.026 | 18,000 | Moderate |
Inflammatory rheumatic diseases in adults | – | 2.2–3.0 | Approx. 1.5–2.1 million adults | Moderate |
Juvenile idiopathic arthritis | 0.07–0.13 | 0.10 | Approx. 14,000 children and young peoplee | Moderate |