A new national cohort study reported that childhood noninfectious uveitis is more common than previously estimated and is disproportionately represented among children from socioeconomically deprived and ethnically diverse backgrounds.
Researchers used the Uveitis in Childhood National Cohort Study identified key demographic, geographic, and clinical features of the disease across the U.K.
“Previous estimates of incidence of childhood uveitis in the U.K. have been drawn from regional studies or have been restricted to disease subsets such as those with uveitis associated with juvenile idiopathic arthritis (JIA),” they noted in their study published in the British Journal of Ophthalmology
The researchers cited increased prevalence of other immune-mediated disorders since the COVID-19 pandemic, as well as changes in subtypes of uveitis, as possible reasons for the changes in disease incidence. Their work, led by Ameenat Lola Solebo of the Population Policy and Practice Research and Teaching Department at the UCL GOS Institute of Child Health in London, sought to “provide population-based evidence on incidence, distribution and disease characteristics for childhood onset noninfectious uveitis.”
U.K. residents under 18 who were newly diagnosed with noninfectious uveitis were included in analyses from March 2020 to February 2023. Nearly 470 cases were identified across 31 National Health Service hospitals, and 255 children were ultimately enrolled in the study. Clinical and demographic data were collected through the Paediatric Ocular Inflammation Group and stored in a centralized REDCap database.
Approximately half of patients (52.2%) were female, and median patient age was 10.1 years. Patients’ ages were found to be a bimodal distribution with peaks at ages 4 to 7 and 11 to 15. Ethnic demographics included White British, Asian/Asian British, and Black/Black British. The researchers noted that non-White ethnic groups were overrepresented relative to the U.K. population.
They found that the national minimum annual incidence of childhood noninfectious uveitis was 1.89 per 100,000 children. Incidence was highest in London (3.13/100,000) and lowest in the northeast of England (1/100,000). Estimated national incidence (adjusted for full coverage) was 2.18/100,000.
Children in the most deprived areas had a relative risk (RR) of 1.57 for disease. Children that are Black and Asian had RRs of 1.76 and 1.21, respectively.
Most (76.9%) patients had anterior uveitis, though 7.2% had intermediate uveitis, 6.3% had panuveitis, and 1.8% had posterior uveitis. Sixty-five percent of patients had bilateral disease. Of patients who had unilateral disease, the right eye was involved in 41 cases and the left eye was involved in 36.
Incidence of associated systemic conditions were JIA in14.5% and tubulointerstitial nephritis and uveitis in 4.7%. Other conditions included sarcoidosis, inflammatory bowel disease, Behçet’s disease, and type 1 diabetes (less than 3 cases each).
At diagnosis, 44.3% of patients had vision loss in at least one eye. Common complications were ocular hypertension, macular oedema, cataract, corneal opacity involving the visual axis, or retinal or choroidal lesions causing irreversible negative impacts on central acuity or the visual field.
JIA-associated uveitis was lower than anticipated based on previous research, the investigators noted. They hypothesized that a true decline may be a result of steroid-sparing, disease-modifying antirheumatic drugs for JIA cases. They also noted that JIA may be identified in the cohort later because eye involvement may occur before arthropathy.
The overrepresentation of underserved groups may have wide implications, they described: In addition to social needs and gaps in health care access, JIA has been found to occur more commonly in children from White British/ North and West European backgrounds.
“There is a need to reconsider how best to deliver pediatric rheumatological and eye care that meets the needs of young people, as well as young children, with uveitis,” the researchers concluded. “The predominance of non-JIA-related uveitis calls for a shift in focus. There appears to be socioeconomic drivers of disease risk, which are worthy of future exploration, and which have implications on the delivery of care for this chronic and blinding disease.”
No competing interests were declared.
