Perthes' disease: deprivation and decline

Perry, Daniel C.; Bruce, Colin; Pope, Daniel; Dangerfield, Peter; Platt, Mary Jane; Hall, Andrew J.

doi:10.1136/archdischild-2011-300413

Cited by 22 publications

(20 citation statements)

References 21 publications

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“…Longitudinal trends in Perthes’ disease discharges across Scotland were also compared to recent incidence studies of Perthes’ disease within the UK 2 5…”

Section: Methodsmentioning

confidence: 99%

Perthes’ disease of the hip: socioeconomic inequalities and the urban environment

et al. 2012

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“…Longitudinal trends in Perthes’ disease discharges across Scotland were also compared to recent incidence studies of Perthes’ disease within the UK 2 5…”

Section: Methodsmentioning

confidence: 99%

Perthes’ disease of the hip: socioeconomic inequalities and the urban environment

et al. 2012

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“…17 The 2011 analysis of the Merseyside Perthes disease register has examined temporal trends over a 34-year period. 8 In Liverpool, Perthes disease rates had almost halved over this time period, from 14.2 to 7.7 cases per 100,000 children aged 0-14 years. Nearby Knowsley showed a similar decline in incidence while the more affluent neighbouring area of Sefton demonstrated no such decline.…”

Section: The Urban Environmentmentioning

confidence: 99%

“…There were no robust studies of incidence among individuals of predominantly black ancestry, which is likely to be a reflection of the scarcity of disease in this group (supported by a paucity of black people featuring among larger published series of disease). 7,8 Most of the studies of Perthes disease incidence arose in northern Europe (Fig 2), prompting the suggestion that latitude may be associated with the disease. After adjustment for race and exclusion of the single study conducted in the southern hemisphere, every 10 degrees further north from the equator resulted in an increase in the incidence of disease by almost 50%.…”

Section: Geography International Incidencementioning

confidence: 99%

“…Perthes disease affects boys around four times more commonly than girls. 8,12 The age of onset of disease demonstrates a marked positive skew, meaning that most cases present between 4 and 7 years old, with a few cases still appearing late in adolescence. 12 Another well-described individual characteristic is a growth abnormality.…”

Section: Personmentioning

confidence: 99%

“…[15][16][17] Analysis of the Merseyside Perthes register from 2011 continues to show marked variation in regional incidence across Merseyside. 8 This analysis used computerised allocation of postcodes to ward regions (primary unit of administrative electoral geography), a tightly defined case definition and multiple case finding methods to ensure that the observed differences were real. It was identified that incidence rates incidence per 100,000 children aged 0-14 years PERRy unravelling tHe enigma oF pertHes disease varied by around five times between wards after excluding outliers.…”

Section: Local Incidencementioning

confidence: 99%

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Unravelling the enigma of Perthes disease

Perry¹

2013

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Perthes disease is an idiopathic avascular necrosis of a juvenile hip. Although 2010 marked a century since it was first described, the aetiology remains unknown. It is suggested that adverse socioeconomic circumstances may be a key precipitant. This work describes recent studies that explore the disease epidemiology. Descriptive studies include a case register from Merseyside, hospital discharge data from Scotland, analysis of the world’s largest community disease register (General Practice Research Database [GPRD]) and a systematic review of incidence. Analytical studies include a nested case-controlled study in the GPRD and a hospital case-controlled study. The studies demonstrated a striking north–south divide in the UK incidence of Perthes disease, similar to that seen in many adult diseases. There was a sustained fall in disease frequency in all studies, with a narrowing of the north–south divide. There was a strong association with area deprivation, independent of living in an urban environment. Internationally, equatorial regions were unaffected by disease and northern Europe had the highest incidence, which was primarily a function of race although latitude was an independent predictor. Individual characteristics associated with the disease were congenital anomalies of the genitourinary tract and a structural abnormality of arterial calibre. Despite a falling incidence, Perthes disease remains an important cause of child morbidity and exemplifies socioeconomic inequalities. A deprivation-related exposure, acting early in development, appears critical. The aetiological factor in Perthes disease remains elusive but it is likely that unravelling this enigma may unlock additional secrets pertaining to the developmental origins of this and other diseases.

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Skeletal immaturity, rostral sparing, and disparate hip morphologies as biomechanical causes for Legg‐Calvé‐Perthes' disease

et al. 2016

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Legg-Calvé-Perthes' (Perthes') disease is a developmental disease of the hip joint that may result in numerous short and long term problems. The etiology of the disease remains largely unknown, but the mechanism is believed to be vascular and/or biomechanical in nature. There are several anatomical characteristics that tend to be prevalent in children with Perthes' disease, namely: skeletal immaturity, reduced height, and rostral sparing. We present an overview of the literature, summarizing the current understanding of the pathogenesis, particularly related to how the formation of the vasculature to the femoral epiphysis places children aged 5-8 at a higher risk for Perthes' disease, how skeletal immaturity and rostral sparing could increase the probability of developing Perthes' disease, and how animal models have aided our understanding of the disease. In doing so, we also explore why Perthes' disease is correlated to latitude, with populations at higher latitudes having higher incidence rates than populations closer to the Equator. Finally, we present five hypotheses detailing how Perthes' disease could have a biomechanical cause. Clin. Anat. 29:759-772, 2016. © 2016 Wiley Periodicals, Inc.

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Perthes' disease: deprivation and decline

Abstract: There was a marked decline in disease incidence over the study period, particularly in more deprived areas. The magnitude of the association with deprivation, and the changing incidence, strongly suggest that environmental factor(s) are a major aetiological determinant in Perthes' disease.

Cited by 22 publications

References 21 publications

Perthes’ disease of the hip: socioeconomic inequalities and the urban environment

Perthes’ disease of the hip: socioeconomic inequalities and the urban environment

Unravelling the enigma of Perthes disease

Skeletal immaturity, rostral sparing, and disparate hip morphologies as biomechanical causes for Legg‐Calvé‐Perthes' disease

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