Search

OBJECTIVES:The prevalence of celiac disease (CD) varies greatly, potentially because of incomplete ascertainment of cases and small study samples with limited statistical power. Previous reports indicate that the incidence of CD is increasing. We examined the prevalence of CD in a well-defined US county.METHODS:Population-based study in Olmsted County, Minnesota, USA. Using the infrastructure of the Rochester Epidemiology Project, medical, histopathology, and CD serology records were used to identify all new cases of CD in Olmsted County since 2000. Age- and sex-specific and adjusted (to the US white 2000 population) incidence rates for CD were estimated. Clinical presentation at diagnosis was also assessed.RESULTS:Between 2000 and 2010, 249 individuals (157 female or 63%, median age 37.9 years) were diagnosed with CD in Olmsted County. The overall age- and sex-adjusted incidence of CD in the study period was 17.4 (95% confidence interval (CI)=15.2-19.6) per 100,000 person-years, increasing from 11.1 (95% CI=6.8-15.5) in 2000-2001 to 17.3 (95% CI=13.3-21.3) in 2008-2010. The temporal trend in incidence rates was modeled as a two-slope pattern, with the incidence leveling off after 2004. Based on the two classic CD symptoms of diarrhea and weight loss, the relative frequency of classical CD among incident cases decreased over time between 2000 and 2010 (P=0.044).CONCLUSIONS:The incidence of CD has continued to increase in the past decade in a North-American population. [ABSTRACT FROM AUTHOR]

Osteoporosis constitutes a major public health problem through its association with age-related fractures, most notably those of the proximal femur. Substantial geographic variation has been noted in the incidence of hip fracture throughout the world, and estimates of recent incidence trends have varied widely. Studies in the published literature have reported an increase, plateau, and decrease in age-adjusted incidence rates for hip fracture among both men and women. Accurate characterisation of these temporal trends is important in predicting the health care burden attributable to hip fracture in future decades. We therefore conducted a review of studies worldwide, addressing secular trends in the incidence of hip and other fractures. Studies in western populations, whether in North America, Europe or Oceania, have generally reported increases in hip fracture incidence through the second half of the last century, but those continuing to follow trends over the last two decades have found that rates stabilise with age-adjusted decreases being observed in certain centres. In contrast, some studies suggest that the rate is rising in Asia. This synthesis of temporal trends in the published literature will provide an important resource for preventing fractures. Understanding the reasons for the recent declines in rates of hip fracture may help understand ways to reduce rates of hip fracture worldwide. [ABSTRACT FROM AUTHOR]

The impact of primary hyperparathyroidism (HPT) on the population has not been well documented, particularly with respect to asymptomatic HPT. Only 83 deaths were attributed to hyperparathyroidism in the United States in 1999, for a reported death rate of just 0.3 per million per year. Many more patients are affected, of course, and the national hospitalization rate for HPT was 8.0 per 100,000 in 1999, counting 22,000 "all-listed" diagnoses, and 1.8 per 100,000 counting only the 5000 admissions where HPT was the first-listed discharge diagnosis. Surgery was performed on approximately 12,000 hospitalized patients in the United States in 1999, for a parathyroidectomy rate of about 4.4 per 100,000 per year. Overall, the annual incidence of HPT was 20.8 per 100,000 in Rochester, MN, during 1983-1992, although this represented a substantial decline from incidence rates reported a decade earlier. There are no estimates of HPT prevalence from this country, but the figure was 4.3 per 1000 in one Swedish survey. By any of these measures, HPT is more common in women than men and increases with aging in both sexes. Other risk factors are obscure. The cost of parathyroidectomies for HPT has been estimated at $282 million annually in the United States, but no reliable estimate of overall expenditures for HPT has been made, and no formal assessment of the cost-effectiveness of any treatment approach has been carried out. Better data on the disability and costs related to HPT and its treatment will be needed to devise the most efficient approaches to patient management.

Of the fractures linked with osteoporosis, hip fractures are most important in terms of death, functional dependence, and social cost. Reduction of these adverse outcomes depends on preventing hip fractures, which are caused by falling on a biomechanically compromised proximal femur. Skeletal strength depends on the amount of bone and its structural arrangement, whereas the traumatic load on the proximal femur is dictated by the orientation of the fall and other factors. One or several of these underlying mechanisms account for the various risk factors that have been identified for hip fracture, including greater incidence rates among women than men and among white than nonwhite populations. However, the exponentially increasing incidence of hip fractures with age indicates that a complex interplay of factors determines the risk of fracture in each person. The multifactorial nature of the problem suggests that hip fractures will be difficult to prevent even as the fractures and their associated costs continue to rise with the increased number of older people. However, the variability of hip fracture rates within high risk populations in Europe and North America reflects the existence of other powerful risk factors that, if identified, might provide the basis for more effective interventions.

Hip fractures lead to excess deaths and substantial disability. Most are related both to falls and to osteoporosis, which affects one in four post-menopausal white women, but a lesser number of men or women of other races. Consequently, about half of the 1.66 million hip fractures worldwide in 1990 occurred in Europe and North America. Even within these regions, however, there is substantial variation in hip fracture incidence rates, which suggests the existence of important environmental factors that could be manipulated to reduce hip fracture occurrence. This is important because in the United States alone, a quarter of a million hip fractures annually cost over $8 billion, mostly for acute medical care and nursing home services. Future costs will be even greater because populations are ageing rapidly around the world and because hip fracture incidence rates are rising in some regions. The number of elderly is increasing most rapidly in Asia, Latin America, the Middle East, and Africa, and these regions will account for over 70% of the 6.26 million hip fractures expected in the year 2050. Because fracture treatment is expensive, and rehabilitation not always successful, effective prophylaxis offers the only hope of alleviating the enormous social burden of hip fractures.