ArticleFrontiers in medicine2026
Association between childhood tonsillectomy and increased risk of autoimmune disease: a nationwide population-based cohort study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Tonsils and adenoids play crucial roles in the immune system, particularly during early childhood. This study investigated the association between childhood tonsillectomy and/or adenoidectomy and the subsequent development of autoimmune disease. Methods: Using nationwide claims data from the Health Insurance Review and Assessment Service, we identified children aged 0-12 years who received medical care for tonsillar or adenoid disease between January 2007 and January 2008. Participants were classified into surgery (tonsillectomy or adenoidectomy between 2007 and 2013) and non-surgery groups and followed until autoimmune disease diagnosis or June 2023. A Cox proportional hazards model was used to analyze the risk of developing autoimmune disease according to surgery. Results: A total of 84,030 children in the surgery group and 336,120 age- and sex-matched children in the non-surgery group were analyzed, with a mean follow-up duration of 15.56 years. The incidence rates of autoimmune diseases in the non-surgery and surgery groups were 65.3 and 86.5 per 100,000 person-years, respectively. Surgery (vs. non-surgery) was associated with an increased risk of developing systemic lupus erythematosus [hazard ratio (HR) 2.20, 95% confidence interval (CI) 1.55-3.13], ankylosing spondylitis (HR 1.35, 95% CI 1.06-1.72), juvenile idiopathic arthritis (HR 1.69, 95% CI 1.19-2.39), type 1 diabetes (HR 1.34, 95% CI 1.14-1.58), Hashimoto's thyroiditis (HR 1.39, 95% CI 1.22-1.57), and Graves' disease (HR 1.38, 95% CI 1.22-1.56). Overall, surgery was associated with an increased risk of developing autoimmune disease (HR 1.32, 95% CI 1.23-1.41). Conclusion: Tonsillectomy and/or adenoidectomy during childhood was associated with an increased risk of developing autoimmune diseases later in life. These findings suggest a possible association between tonsillar and adenoid immune function and later autoimmune disease risk.
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