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ORIGINAL RESEARCH article

Front. Immunol.

Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders

This article is part of the Research TopicBig data research, precision medicine and real‑world evidence in autoimmune and rheumatic diseasesView all 11 articles

Racial Disparities in Ankylosing Spondylitis Risk Following Tonsillectomy: A Large-Scale Retrospective Analysis

Provisionally accepted
Jiafeng ZhangJiafeng Zhang1*Yadong ChuYadong Chu2Yufeng ZhuYufeng Zhu1Huang Hua BingHuang Hua Bing3Chien Han TsaoChien Han Tsao4Yu Hsun WangYu Hsun Wang5Jame Cheng-Chun WeiJame Cheng-Chun Wei5
  • 1Shanghai Changzheng Hospital, Huangpu, China
  • 2Zhejiang Armed Police Corps Hospital, hangzhou, China
  • 3Changhai Hospital, Shanghai, China
  • 4Chung Shan Medical University Hospital, Taichung, Taiwan
  • 5Chung Shan Medical University, Taichung, Taiwan

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Objective: To investigate the association between tonsillectomy and subsequent ankylosing spondylitis (AS) risk, with particular emphasis on racial disparities in disease susceptibility. Methods: A retrospective cohort study was conducted using de-identified electronic health records from approximately 120 million patients in the collaboration network in the United States. Patients diagnosed with tonsillar and adenoidal diseases between 2005 and 2023 were selected and divided into surgical and non-surgical cohorts. Propensity score matching (PSM) was employed to balance baseline differences and control for confounding factors, and statistical analyses were performed using Kaplan-Meier survival analysis and Cox proportional hazards models. Results: After PSM, 173,483 individuals were included in each cohort with well-balanced baseline characteristics. Overall, tonsillectomy did not significantly increase AS risk (HR = 1.26, 95% CI: 0.90-1.75, p = 0.210). Age-and sex-stratified analyses yielded consistent results. However, race-stratified analysis revealed that White individuals who underwent tonsillectomy had significantly elevated AS risk (HR = 1.80, 95% CI: 1.19-2.72, p = 0.005) and higher cumulative incidence compared to matched controls, a finding not observed in other racial groups. Conclusion: This large-scale study identifies White race as a significant effect modifier in the relationship between tonsillectomy and AS development. These findings warrant closer post-operative surveillance for AS symptoms in White patients undergoing tonsillectomy and further mechanistic research.

Keywords: ankylosing spondylitis, Propensity score matching, Racial Disparities, Retrospective cohort study, Tonsillectomy

Received: 07 Nov 2025; Accepted: 14 Feb 2026.

Copyright: © 2026 Zhang, Chu, Zhu, Bing, Tsao, Wang and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Jiafeng Zhang

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material