Abstract
The prevalence of autoimmune diseases (AIDs) in Ethiopian patients with type 1 diabetes (T1D) is mainly unknown. This study aimed to determine the co-occurrence of AIDs in T1D Ethiopian patients and to compare their prevalence to non-Ethiopian Israeli patients. A retrospective cohort analysis of 12,759 T1D patients, of whom 672 (5.3%) were of Ethiopian descent, aged ≥ 18 years, registered in the Clalit Health Services database was conducted. The AID cases were identified by ICD-10 codes from 2000 to 2023. Additionally, data on thyroid peroxidase antibody (TPO) and tissue transglutaminase (TTG) antibodies were extracted and analyzed. The mean age of the entire cohort was 30.4 ± 18.9 years, 54% were male, and the mean follow-up was 10.9 ± 6.1 years. An additional AID was diagnosed among 14% of the Ethiopian and 26% of the non-Ethiopian populations (p < 0.001), respectively. Although the prevalence of coexisting autoimmune conditions was approximately half in the Ethiopian group, the relative distribution pattern of common and less common AIDs remained similar to that observed in the non-Ethiopian population. The prevalence of AIDs in Ethiopians is lower than in non-Ethiopian patients with T1D, indicating the existence of ethnic differences in susceptibility to AIDs. Nevertheless, the low screening rates highlight the need for greater vigilance and adherence to guidelines by medical staff.
Data availability
The corresponding author Alena Kirzhner will provide the research data upon a reasonable request.
Abbreviations
- AID:
-
Autoimmune disease
- APLA:
-
Antiphospholipid antibodies
- AIT:
-
Autoimmune thyroid disease
- CHS:
-
Clalit Health Services
- CD:
-
Celiac disease
- anti-GAD:
-
Glutamic acid decarboxylase
- GD:
-
Grave’s disease
- IAA:
-
Insulin autoantibodies
- SD:
-
Standard deviation
- TTG:
-
Tissue transglutaminase
- TPO:
-
Thyroid peroxidase
- T1D:
-
Type 1 diabetes
References
Gu, Y. et al. High-throughput multiplexed autoantibody detection to screen type 1 diabetes and multiple autoimmune diseases simultaneously. EBioMedicine 47, 365–372 (2019).
Lebenthal, Y., Yackobovitch-Gavan, M., de Vries, L., Phillip, M. & Lazar, L. Coexistent autoimmunity in familial type 1 diabetes: increased susceptibility in sib-pairs? Horm. Res. Paediatr. 75 (4), 284–290 (2011).
American Diabetes Association Professional Practice Committee. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2024. Diabetes Care. 47 (Suppl 1), S52-S76 (2024).
American Diabetes Association Professional Practice Committee. 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes-2025. Diabetes Care. 48 (Supplement_1), S50-S58 (2025).
The Ethiopian Population in Israel. ; (2024). https://www.cbs.gov.il/he/mediarelease/DocLib/2024/371/11_24_371b.pdf (accessed 14 April, 2025).
Zung, A. et al. Type 1 diabetes in Jewish Ethiopian immigrants in Israel: HLA class II immunogenetics and contribution of new environment. Hum. Immunol. 65 (12), 1463–1468 (2004).
Rubinstein, A., Graf, E., Landau, E., Reisin, L. H. & Goldbourt, U. Prevalence of diabetes mellitus in Ethiopian immigrants. Isr. J. Med. Sci. 27, 252–254 (1991).
Reuven, Y., Dreiher, J. & Shvartzman, P. The prevalence of diabetes, hypertension, and obesity among immigrants from East Africa and the former Soviet Union: A retrospective comparative 30-year cohort study. Cardiovasc. Diabetol. 15, 8–14 (2016).
Benedek, G. et al. Effect of polymorphism in insulin locus and HLA on type 1 diabetes in four ethnic groups in Israel. Tissue Antigens. 73 (1), 33–38 (2009).
Márquez, A. & Martín, J. Genetic overlap between type 1 diabetes and other autoimmune diseases. Semin Immunopathol. 44(1), 81–97. Erratum in: Semin Immunopathol. 44 (1), 99 (2022).
Mäkimattila, S., Harjutsalo, V., Forsblom, C., Groop, P. H. & FinnDiane Study Group. Response to Comment on Mäkimattila Every Fifth Individual With Type 1 Diabetes Suffers From an Additional Autoimmune Disease: A Finnish Nationwide Study. Diabetes Care 43, 1041–1047; 43 (8), e106-e107 (2020).
Prinz, N. et al. Characteristics of Patients with Type 1 Diabetes and Additional Autoimmune Disease in the DPV Registry. J. Clin. Endocrinol. Metab. 106 (9), e3381–e3389 (2021).
Gimenez-Perez, G. et al. Comorbid autoimmune diseases and burden of diabetes-related complications in patients with type 1 diabetes from a Mediterranean area. Diabetes Res. Clin. Pract. 191, 110031 (2022).
Lindgren, M. et al. Prevalence and Predictive Factors for Celiac Disease in Children With Type 1 Diabetes: Whom and When to Screen? A Nationwide Longitudinal Cohort Study of Swedish Children. Diabetes Care. 47 (4), 756–760 (2024).
Mohammedsaeed, W. M. & Alghamdi, Z. J. Autoimmune diseases and their prevalence in Saudi Arabian patients with type 1 diabetes mellitus. Saudi Med. J. 44 (8), 751–760 (2023).
Gkrouzman, E., Peng, M., Davis-Porada, J. & Kirou, K. A. Venous thromboembolic events in African American lupus patients in association with antiphospholipid antibodies compared to white patients. Arthritis Care Res. (Hoboken) 74(4), 656–664 (2022).
Denvir, B. et al. Prevalence of concomitant rheumatologic diseases and autoantibody specificities among racial and ethnic groups in SLE patients. Front. Epidemiol. 4, 1334859 (2024).
Kirzhner, A. et al. Distinct complication profiles: a comparative study of Ethiopian and non-Ethiopian adults with type 1 diabetes. Front. Endocrinol. (Lausanne). 16, 1664230 (2025).
Alter, M., Kahana, E., Zilber, N. & Miller, A. Multiple sclerosis frequency in Israel’s diverse populations. Neurology 66 (7), 1061–1066 (2006).
Niznik, S. et al. Ethnicity and Antiphospholipid Syndrome in Israel. Arthritis Care Res. (Hoboken). 74 (11), 1917–1923 (2022).
Gudeta, A. N. et al. Distribution of HLA-DQ risk genotypes for celiac disease in Ethiopian children. HLA 96 (6), 681–687 (2020).
Gudeta, A. N., Brundin, C., Muleta Feyissa, D., Tolera Balcha, T. & Agardh, D. Prevalence of celiac disease autoimmunity in Ethiopian pregnant women: a cross sectional study from the Oromia region. Int. J. Celiac Dis. 7 (3), 74–77 (2019).
Gudeta, A. N., Andrén Aronsson, C., Binagdie, B. B., Girma, A. & Agardh, D. Incidence of celiac disease autoimmunity and associations with maternal tuberculosis and pediatric Helicobacter pylori infections in 4-year-old Ethiopian children followed up in an HLA genotyped birth cohort. Front. Pediatr. 10, 999287 (2022).
Makharia, G. K., Chauhan, A., Singh, P. & Ahuja, V. Review article: epidemiology of coeliac disease. Aliment. Pharmacol. Ther. 56 (Suppl 1), S3–S17 (2022).
Abu-Zekry, M., Kryszak, D., Diab, M., Catassi, C. & Fasano, A. Prevalence of celiac disease in Egyptian children disputes the east west agriculture-dependent spread of the disease. J. Pediatr. Gastroenterol. Nutr. 47 (2), 136–140 (2008).
Ackerman, Z., Livovsky, J. & Livovsky, D. M. Celiac disease in an Ethiopian Jew. Isr. Med. Assoc. J. 16 (6), 395–396 (2014).
Makhani, N. et al. MS incidence and prevalence in Africa, Asia, Australia and New Zealand: A systematic review. Mult Scler. Relat. Disord. 3, 48–60 (2014).
Tsega, E., Choremi, H., Bottazzo, G. F. & Doniach, D. Prevalence of autoimmune diseases and autoantibodies in Ethiopia. Trop. Geogr. Med. 32 (3), 231–236 (1980).
Acknowledgements
We thank Merav Greenstein, Tamar Zohar and Amit Davidpur for their valuable help during the study.
Funding
This study was supported by a grant from the Russell Berrie Galilee Diabetes Sphere of the Azrieli Faculty of Medicine Br-Ilan University (AK, AB & TS; SPCL2023003).
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AK: Conceptualization, methodology, investigation, visualization, supervision and writing original draft. AB: Methodology, investigation, visualization, review & editing, supervision. HG: Methodology, investigation, visualization, review & editing. HAK: Methodology, investigation and visualization. MA: Investigation and visualization. MZD: Investigation and visualization. RC: Investigation and visualization. TS: Conceptualization, methodology, investigation, visualization, supervision, and writing original draft.
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Kirzhner, A., Bashkin, A., Green, H. et al. Autoimmune disease prevalence in Ethiopian versus Non-Ethiopian type 1 diabetes patients in Israel. Sci Rep (2026). https://doi.org/10.1038/s41598-026-41046-9
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DOI: https://doi.org/10.1038/s41598-026-41046-9
