Increasing prevalence of Addison's disease in German females: health insurance data 2008–2012

Abstract

Objective: Our objective was to investigate the epidemiology of autoimmune Addison's disease (AD) in Germany. Design: Routine data were analyzed from the Statutory Health Insurance (SHI) database of the Techniker Krankenkasse (TK) for an observation period from 01/01/2008 to 31/12/2012. The TK is one of the largest German health care insurance providers covering more than 10% of the German population. Subjects and methods: Between 2008 and 2012, a total of 2477 diagnoses of primary adrenal failure were recorded in the SHI database. After exclusion of secondary, iatrogenic or other non-idiopathic forms and after adjustment for incomplete data sets, 1364 diagnoses of autoimmune-mediated AD remained. Results: The prevalence of AD in our cohort showed a steady increase from 82 per million in 2008 to 87 per million in 2012. On average, the prevalence rose about 1.8% per year, and due to a pronounced increase (2.7%) in females. The prevalence was lower in men (63-68 per million) than in women (96-108 per million). Autoimmune comorbidities were found in 46.5% of AD patients. Adrenal crises were documented with a frequency of 14-17/100 patient years. Conclusions: These data provide a first epidemiological profile of this rare and perilous endocrine disease in Germany. Although the prevalence of AD appears lower than in the Scandinavian countries, the increasing figures in females over the last 5 years warrant further investigations. Furthermore, adrenal crises pose a considerable burden. Hereby, we can show that health insurance data provide a valuable tool for epidemiological studies in the absence of national registries.

Daily adjustment of glucocorticoids by patients with adrenal insufficiency

“…However, if the days with discomfort and no dose increase (65% of days with discomfort) were relevant sick days with significant health impairment, this would have led to a significant increase in adrenal crises. In contrast, we only observed two adrenal crises during the documented period (93.4 years), which is below the reported frequency …”

MANAGEMENT OF ENDOCRINE DISEASE: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review

“…However, lower prevalence rates have been reported outside Europe (11,12,13). The incidence has been estimated at 4-6 cases per million per year and is probably on a rising course (5,7,8,10,14,15,16).…”

“…A life-threatening adrenal crisis is, unfortunately, a common event in PAI on replacement therapy. Recent studies provide evidence of an annual incidence of adrenal crisis of 5-17% (16,99,100,101,102,103) and show that 47% of PAI patients have experienced at least one acute adrenal crisis after diagnosis (100). In the first prospective study on adrenal crisis a total of 423 patients (PAI, n = 221; secondary adrenal insufficiency (SAI), n = 202) were followed up for 2 years; 10 patients died during follow-up (PAI, n = 5; SAI, n = 5), and at least 4 deaths were associated with adrenal crisis (0.5 adrenal-crisis-related deaths per 100 patients-years) (101).…”

The potential role for infections in the pathogenesis of autoimmune Addison’s disease

“…However, although the concordance rate of monozygotic twins is high at 0·73, the involvement of additional variables such as environmental factors is very likely. This is supported further by an apparent increase in the incidence of AAD in Europe during recent decades . Knowledge of AAD is scarce in other parts of the world, but epidemiological data indicate that the prevalence is exceedingly far lower in the Far East and South Africa than in Europe .…”