Estimating the Prevalence of Noninfectious Uveitis with a Massive Claims Database

The prevalence of noninfectious uveitis was 121 cases per 100,000 adults and 29 cases per 100,000 children. By such estimates, nearly 300,000 adults and 22,000 children in the United States had the disease in 2015.

Prevalence estimates are crucial not only for determining how widespread uveitis is but also for estimating the amount of healthcare resources needed to treat it. Obtaining realistic prevalence estimates for uveitis is particularly important because the cost of treating its various forms may be similar to the cost of treating diabetic retinopathy. And because treatment of noninfectious uveitis (NIU) usually depends on its anatomic class, obtaining good estimates of the prevalence of each anatomic class of NIU is also crucial.

Until recently, few studies had estimated the prevalence of NIU in general or by inflammation location, presence of systemic conditions, sex, age, or severity. However, in September of 2016, a team of US investigators led by Jennifer Thorne, MD, of Johns Hopkins School of Medicine analyzed a large administrative claims database, the OptumHealth Reporting and Insights database, to estimate these prevalences in a population of 14 million privately insured employed persons in 2012. The team published the results of their analysis in the September 8, 2016, issue of JAMA Ophthalmology.

The study included patients who had two or more diagnoses of uveitis on separate days in 2012 and who were continuously enrolled in a health plan throughout 2012. The study team defined children as those <18 years old.

The team made the following estimates based on their analysis:

  • Prevalence of uveitis of all types: 133 cases/100,000 adults; 31 cases/100,000 children
  • Prevalence of NIU: 121 cases/100,000 adults; 29 cases/100,000 children

Using these prevalences, they estimated that nearly 300,000 adults and nearly 22,000 children had NIU in the United States in 2015.

Additionally, they estimated the prevalence of NIU by location to be as follows:

  • Anterior: 98 cases/100,000 adults; 22 cases/100,000 children
  • Intermediate: 1 case/100,000 adults; 0 cases/100,000 children
  • Posterior: 10 cases/100,000 adults and 3 cases/100,000 children
  • Panuveitis: 12 cases/100,000 adults and 4 cases/100,000 children.

They noted that most cases of NIU were anterior uveitis: NIU was anterior in 81% of adults and 75% of children. In addition, approximately 11% of cases of anterior NIU in adults were associated with systemic disease, and 26.2% cases in children were associated with juvenile idiopathic arthritis.

Furthermore, they found that the prevalence of uveitis was higher in women than in men and increased with age to 220/100,000 elderly (those ≥65 years old).

In a related editorial, Douglas Jabs, MD, MBA, from the Icahn School of Medicine at Mt. Sinai, New York City, noted that one of the study’s major strengths was the size of the database used.

The study was, however, limited by an absence of data on race and ethnicity, which “might have provided insight into regional variations in prevalence and type,” Jabs noted. Another limitation was the absence of the publicly insured and uninsured from the database, which may limit the generalizability of the study’s estimates.

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