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How many people are immunocompromised?

JeanTate

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And what are the trends?

In searching for answers I found this, from 2015, by Theo Schall: How Many Americans are Immunocompromised?

The answer seems to be "no one really knows, because it's not tracked".

There may be other advanced economies where this is tracked, does anyone know?

So what are the causes? Schall writes:

Patients can either be born with an immune deficiency or they can acquire one. While it’s relatively rare to be born with an immune deficiency, over 200 different hereditary and genetic defects can cause a “primary” immunodeficiency. Acquired immune deficiency also has a variety of causes, including cancer and its treatments, the immunosuppressant drugs taken by transplant recipients and people with autoimmune disorders, malnutrition, aging, and HIV/AIDS.
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In terms of trends, I imagine/guess that the population incidence of primary immune deficiency has likely increased somewhat, over the past half century or so, because more is known than back then and it's less of a death sentence for babies and toddlers.

The population incidence for several of the acquired immune deficiency causes (if that makes sense) has also increased; 50 years ago there were ~no people with HIV/AIDS (in the US anyway), nor transplant recipients; too, fewer cancer survivors (or even patients). For autoimmune disorders, malnutrition, and aging?

What surprised me somewhat is just how many people (again, in the US at least) are likely to be immunocompromised.
 
JeanTate said:
And what are the trends?

In searching for answers I found this, from 2015, by Theo Schall: How Many Americans are Immunocompromised?

The answer seems to be "no one really knows, because it's not tracked".

......
What surprised me somewhat is just how many people (again, in the US at least) are likely to be immunocompromised.
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No one knows, but you are surprised at how many? Huh?

How about an estimate in percent? eta, from you link above I get about 1%.
 
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casebro said:
No one knows, but you are surprised at how many? Huh?

How about an estimate in percent? eta, from you link above I get about 1%.
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I get somewhere between 10% and 20%, which is a WAG. I was expecting perhaps 1-3%. The biggest groups, numerically seem to be the elderly, the malnourished, and cancer patients and survivors.

There's clearly a grade; for example, a really fit 65 year old may have an immune system that is only marginally weaker than a really fit 25 year old, but double lung transplant recipient will surely be severely immunocompromised. And there's clearly a lot of overlap.
 
JeanTate said:
I get somewhere between 10% and 20%, which is a WAG. I was expecting perhaps 1-3%. The biggest groups, numerically seem to be the elderly, the malnourished, and cancer patients and survivors.

There's clearly a grade; for example, a really fit 65 year old may have an immune system that is only marginally weaker than a really fit 25 year old, but double lung transplant recipient will surely be severely immunocompromised. And there's clearly a lot of overlap.
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10%-20% is not a swag, it is a gross exaggeration.

"food insecurity" does not equal "malnourished". I don't see how worrying about your food supply can cause immunosuppression. So toss that right out.

10%-20% is not a swag, it is a gross exaggeration.
 
Thanks.

casebro said:
10%-20% is not a swag, it is a gross exaggeration.
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I have no basis for accepting or rejecting any of Schall's categories, and not much basis re his own estimates (yeah, some would be fairly easy to check).

I see overlaps as a big uncertainty ... they surely exist (as Schall himself says), but how to estimate them?

"food insecurity" does not equal "malnourished". I don't see how worrying about your food supply can cause immunosuppression. So toss that right out.
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Indeed.

Malnutrition does exist in the US (should I cite some sources?). And malnutrition can cause a suppression of the immune system. But how to estimate the numbers of people, in the US, whose immune systems are compromised by malnutrition?

10%-20% is not a swag, it is a gross exaggeration.
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What would you estimate it to be (show your working)? How would your estimate relate to the categories in the article by Schall?

Re cancer patients: not everyone undergoing cancer treatment will have their immune systems suppressed (though a good default is that all will). A much grayer area is those who have finished their treatments, "survivors". Sadly, some of these have finished their treatments because nothing works any more; they will be very sick and very likely immunocompromised. Those in remission (NED is a truly magic word): some time after their treatment ends (6 months?), many will have immune systems that are "back to normal". However, many others will never be back to normal, their treatments will have left them with permanently damaged immune systems. In this case, I think Schall downplays the extent:
Schall said:
The number of cancer patients whose immune systems are currently suppressed by treatment protocols is somewhere in between these figures. Many patients who were diagnosed last year are still in treatment, whereas plenty of the long-term survivors have likely finished their treatment processes.
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The elderly? Is it because they are elderly and our immune system naturally weaken as we age? Why include the elderly in a category with folks who have congenital diseases or have immune systems that have been compromised by chemo therapy or organ transplants?

Stress and lack of sleep also "suppress" the immune system, are these considerations?

Seems like such a broad categorization as to not be very useful honestly.
 
ahhell said:
The elderly? Is it because they are elderly and our immune system naturally weaken as we age?
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You may find this review interesting: Immune function in older adults

Why include the elderly in a category with folks who have congenital diseases or have immune systems that have been compromised by chemo therapy or organ transplants?
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Because their immune systems are "compromised".

Stress and lack of sleep also "suppress" the immune system, are these considerations?
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Good question. Not a category Schall considered, apparently; I wonder why not?

Seems like such a broad categorization as to not be very useful honestly.
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One use: to estimate the numbers of people especially susceptible to measles, or any other previously "under control" contagious viral infection.
 
I was told by my specialists that poor control of t1 diabetes could cause one to become immunocompromised,

which would imply that if one had good control of t1 diabetes then one wouldn't.

I'm not sure I accept that, not sure immunocompromisation could be an on and off thing, I need to go read more.
 
JeanTate said:
You may find this review interesting: Immune function in older adults



Because their immune systems are "compromised".



Good question. Not a category Schall considered, apparently; I wonder why not?


One use: to estimate the numbers of people especially susceptible to measles, or any other previously "under control" contagious viral infection.
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Which makes as much sense as estimating the numbers of people that have a genetic immunity. Yes, some people are immune to some viruses.
 
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