An Invisible Epidemic: Why America Isn’t Paying Enough Attention to Autoimmune Diseases


As advances in information technology – data collection and analysis – accelerate research in genomics, immunology, microbiomics, and systems biology, we’ve entered into a period of unprecedented innovation in healthcare. We can now dream of a future where every person gets the right care at the right time, even before disease strikes.

The major topics in disease research have been cancer, cardiovascular disease, and diabetes, however, a topic that needs to join that list is chronic disease, especially autoimmune disease. Autoimmune disease is an invisible epidemic. Like the name suggests, it is a disease that commonly leaves no physical traces or symptoms making the patients appear superficially well. It affects 16% of the american population, yet remains under-recognized, under-served, and under-funded. As this continues, the United States is facing a growing financial and social burden managing chronic diseases. Take a look at the numbers:

  • The U.S. already spends 85 percent of health care dollars on people with chronic conditions.
  • Between 2000 and 2030, the number of Americans living with chronic disease is predicted to increase by 37 percent, adding up to 46 million people.
  • Most alarming: 27 percent of children under 19 years old have at least one chronic condition, and 6 percent suffer from more than one.

The under-appreciated contributor to this chronic disease burden is autoimmune disease. This is significant because autoimmune diseases are high-morbidity and moderate-mortality chronic conditions. However, autoimmune diseases are not grouped under one category-instead these  80 to 100 diseases are scattered among various body systems and specialists. As a result, approximately $1 trillion spent on healthcare per year is in treatment of chronic disease and patients cost the system (payers and themselves) $281 billion each year.

A closer look at the numbers available reveals that autoimmunity slips through the cracks. The chart below prepared by the US Governmental Agency for Healthcare Research and Quality scatters autoimmune diseases across multiple categories.

graph 1

Graph 1 — Agency for Healthcare Research and Quality. Multiple Chronic Conditions Chart Book

Two of the most prevalent autoimmune conditions are Hashimoto’s and Graves’ disease — but you wouldn’t know that from this chart as they are lumped into the “thyroid disorders” category. Likewise, “arthritis” lumps all types into one category. So, how much of “arthritis” is actually Rheumatoid Arthritis, Psoriatic Arthritis, Systemic Lupus Erythematosus and other autoimmune diseases of the joints?

Similarly, here’s another chart prepared by Kaiser, the oldest healthcare provider.


Endocrine disorders are all grouped into one category. How many autoimmune diseases are lost in the endocrine or ill-defined conditions categories? How much of dermatological disease is Psoriasis? Where do Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE), Crohn’s and Inflammatory Bowel Disease (IBD), all major autoimmune diseases, fit in?

By not aggregating and considering autoimmune diseases as it’s own category, we are blind to them. We are missing an opportunity to target a large and growing cause of chronic suffering, simply because we haven’t defined it into statistical existence.

Autoimmune Disease is an Unacknowledged Public Health Crisis

While there is some aggregated autoimmune data out there, it has been cobbled together from various sources. The most comprehensive source for autoimmune data is the American Autoimmune Related Diseases Association. However, because of funding limitations this data isn’t current. Here’s what we know:

  • Taken together, the number of people suffering from autoimmune diseases is 24–50 million Americans, 16% of the U.S. population. To put it in perspective, autoimmune disease prevalence equals heart disease and cancer combined.
  • Best estimates of the total autoimmune disease financial burden are around $100 Billion. However, this number was based on data from the last decade and we suspect it to be much lower than the actual since psoriasis (just one autoimmune disease out of 80+) estimated a total U.S. cost of $112 Billion in 2013 alone.
  • Autoimmune diseases are among the top 10 causes of death in girls and women under 65 years.
  • IBD seems to be increasing in children, according to a 12-year study showing an incidence rate doubling over 1991–2002.

So why haven’t we declared war on autoimmune disease as we did on cancer in 1971? Cancer ranks as the second largest cause of death. But, if you combine all the different types of autoimmune conditions, they could threaten cancer’s second place ranking.

One reason cancer gets so much government funding and research attention is that cancers combined are a much bigger target than cancers considered individually. Cancer as a category is easily found, and the myriad of individual cancers are easily combined together.

Additionally, the “invisible” nature of autoimmunity only further hinders its chances of getting more attention and support. Most diagnosed cancer patients look sick (especially under treatment). In contrast, most autoimmune patients look superficially well, even while suffering significant morbidity, lost productivity and debilitating financial stress.

As we mentioned earlier, the autoimmune category consists of 80 to 100 diseases, many very rare, widely scattered over a number of medical specialties, and usually grouped by body system (digestive, joints, metabolic) rather than as a category with common causal mechanisms (immune system attacks own tissues). Consequently, diagnosis and treatment are a notoriously exhausting journey, with patients seeing on average five doctors over three and a half years before receiving a diagnosis.

Getting Autoimmune Disease on the Chronic Disease Map

We are overdue on conducting proper research to understand the causes, patterns and effects of autoimmune disease. We must code, collect or transform the data so that autoimmune diseases can be looked at as a single category in order to calculate the total burden of autoimmunity and get more needed resources and research efforts. Improved tracking of these diseases should allow us to include autoimmune disease in the CDC’s chronic disease prevention approach described below.

graph 3

Autoimmune diseases are already a huge burden, socially, financially and emotionally. We need faster diagnosis, better-matched treatments, and even pre-autoimmune prevention. We already have some of the tools, and through research and analysis, we know we can find much more. We need to start identifying and counting autoimmune diseases to find the resources and give hope to millions of Americans.

DrBonnie360 is Your Autoimmunity Connection to building bridges across the autoimmune abyss. We collaborate with others to reshape diagnosis, treatment, and prevention for autoimmune patients now and for generations to follow.

Learn more about autoimmune diseases and find out the best treatments on The Wahls Protocol.


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