Background and Aims

Background: Holocaust-survivors suffer from higher rates of various morbidities. It is speculated that this phenomenon is due to exposure to the extreme stress and horrors of that era. In this study we hypothesized that these factors contributed to higher rates of autoimmune disease in Holocaust-survivors.

Objective: To evaluate the prevalence rate of several autoimmune diseases among Israeli Holocaust-survivors in comparison with their peer group within the general population.

Methods

Design: A cross-sectional study, based on Israel’s biggest HMO digital health records, spanning from January 2002 up to March 2019.

Population: Members of Clalit Healthcare services that survived the Holocaust were matched by age and gender, in a 1:1 ratio, to non-survivor members.

Statistics: Autoimmune diseases were analyzed separately and as a composite autoimmunity variable. Prevalence rates were calculated for both the Holocaust-survivor group and their matched controls. Then crude and adjusted prevalence odds ratios (POR) were calculated.

Results

Results: 105,995 Holocaust-survivors and another 105,995 matched controls were included in the analysis. We found a prevalence rate of autoimmune disease among Holocaust-survivors of 87 per 1,000 (0.087). Psoriasis was the most prevalent disease among both the survivor and control groups, with a prevalence of 46 per 1,000 (0.046) and 14 per 1,000 (0.014) respectively. The adjusted POR for autoimmunity was 3.6 (95% CI, 3.4-3.8); and as high as 3.9 (95% CI, 2.8-5.5) for Graves’ disease.

Conclusions

Conclusions: We found that Holocaust-survivors suffer from higher rates of autoimmune morbidity. Furthermore, we found a strong association between exposure to the horrors of the Holocaust and autoimmunity.