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Background  Currently, most research on hemophagocytic lymphohistiocytosis (HLH) have focused on etiology and therapy, leaving few epidemiological reports. The published studies of China are mainly regional investigations. We aimed to present the overall epidemiological status of HLH in China, and provide Chinese data for the international HLH epidemiological investigation.    Methods  The data of HLH cases in China in 2019 were collected and statistically analyzed.    Findings  Epstein-Barr virus accounted for 44.01% of the 1445 cases in 31 regions and was the most common cause. Lymphoma-associated HLH patients were more often male ( P  < 0.05) while rheumatic and immune-associated HLH were more often female ( P  < 0.001). Primary HLH and Epstein-Barr Virus-associated HLH were predominant in children ( P  < 0.001) while tumor-associated HLH was predominant in adults. Lymphoma-associated HLH was positively correlated with the age of onset ( P  < 0.01). The diagnosis rate of 29 areas had a significant correlation with per capita Gross domestic product ( P  < 0.05).    Conclusion  The different distribution of HLH etiology by age and gender contributes to the diagnosis of HLH by clinicians; The suboptimal diagnosis rate in regions with a high incidence of HLH in China is a result of the effect of the local economic level indicating the importance of improving the regional medical level.

Epidemiological investigation of hemophagocytic lymphohistiocytosis in China