Perthes' disease of the hip in Liverpool.

Hall, Andrew J.; Barker, D. J. P.; Dangerfield, Peter; Taylor, John F.

doi:10.1136/bmj.287.6407.1757

Cited by 68 publications

(75 citation statements)

References 9 publications

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“…The disease is 4 times more common among boys, and there is bilateral involvement in 8% to 24% of cases 1--3 . The reported annual incidence varies between 0.45 cases per 100 000 among black children in South Africa 4 , 0.9 cases per 100 000 among children in Japan 5 , and 21 cases per 100 000 among children in Liverpool, England 6 . In Uppsala, Sweden, the annual incidence was identified as 8.5 cases per 100 000 among children 0 to 14 years of age in 1978 -1989 7 .…”

Section: What This Study Addsmentioning

confidence: 99%

Legg-Calvé-Perthes Disease and Risks for Cardiovascular Diseases and Blood Diseases

et al. 2010

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OBJECTIVE:We hypothesized that patients with Legg--Calvé--Perthes disease (LCPD) might have higher risks of cardiovascular and blood diseases. METHODS: A total of 2579 patients with LCPD diagnosed between 1965 and 2005 were identified with the Swedish Inpatient Register. A total of 13748 individuals without LCPD were selected randomly from among the Swedish general population, with matching according to year of birth, age, gender, and region of residence. Cox proportional--hazard regression analyses, with adjustment for socioeconomic index, were used to estimate relative risks. The patients also were compared with their same--gender siblings. RESULTS: Patients with LCPD had a hazard ratio (HR) of 1.70 (95% confidence interval [CI]: 1.48 -1.95) for cardiovascular diseases, compared with individuals without LCPD. There were statistically significantly higher risks for hypertensive disease, ischemic heart diseases, cerebrovascular diseases, diseases of arteries, veins, and lymphatic vessels. There were statistically significantly higher risks for blood diseases, including anemias and coagulation defects (HR: 1.94 [95% CI: 1.51-2.49]), which were more pronounced among subjects >30 years of age at the follow--up (HR: 2.45 [95% CI: 1.77-3.41]). Patients also had statistically significantly higher risks of nutritional anemia (HR: 2.32 [95% CI: 1.41 -3.81]) and hemolytic anemia ). Analyses using siblings as the comparison group showed consistent results for cardiovascular diseases. CONCLUSION:The results are consistent with the hypothesis that an insufficient blood supply to the femoral head, attributable to vascular pathologic conditions, is involved in the pathogenesis of LCPD.

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Section: What This Study Addsmentioning

confidence: 99%

Legg-Calvé-Perthes Disease and Risks for Cardiovascular Diseases and Blood Diseases

et al. 2010

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“…6 In Britain, Barker, Dixon and Taylor 7 showed that the highly urbanised Mersey area had an annual incidence of 11.1 per 100 000, whereas in the predominantly rural Wessex it was 5.5 per 100 000. Hall et al 8 noted an annual incidence in Liverpool of 15.6 per 100 000. Because of this variation, it has been felt that an environmental factor must play a significant role and that Perthes' disease has a predisposition for urban areas and areas of high social deprivation.…”

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confidence: 99%

Deprivation, urbanisation and Perthes’ disease in Northern Ireland

Kealey

Moore²,

Cook³

et al. 2000

The Journal of Bone and Joint Surgery. British volume

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It has been suggested that Perthes' disease is more prevalent in urban areas, and that the risk increases with deprivation. We present the findings of a preliminary analysis of Perthes' disease in Northern Ireland, which is shown to have one of the highest national annual rates of incidence in the world (11.6 per 100 000). Of the 313 children diagnosed over a seven-year period, 311 were allocated to the enumeration districts of the 1991 census, thus allowing the incidence to be calculated using both spatial and non-spatial aggregation. The cases were grouped according to the size of the settlement from highly urbanised to open countryside and by level of area deprivation. While the incidence of Perthes' disease was found to be associated with indicators of the level of deprivation for areas, there was no evidence to suggest that there was an increased risk in urban areas; the highest rate was found in the most deprived rural category.

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“…15,17 This revealed a steep social class gradient associated with Perthes disease, with incidence rates rising from 4 per 100,000 per annum in Social Class 1 (highest social standing) to 31.7 per 100,000 per annum in Social Class 5 (lowest social standing). 15 However, social class and deprivation trends have remained a source of controversy. 18 The recent Merseyside and GPRD studies have re-examined deprivation at a local and national level.…”

Section: Explaining Geographic Variation Deprivationmentioning

confidence: 99%

“…Investigations of the regional incidence in Merseyside and Yorkshire in the 1970s and 1980s demonstrated marked variation in these counties. [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.…”

Section: Local Incidencementioning

confidence: 99%

Unravelling the enigma of Perthes disease

Perry¹

2013

annals

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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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Perthes' disease of the hip in Liverpool.

Cited by 68 publications

References 9 publications

Legg-Calvé-Perthes Disease and Risks for Cardiovascular Diseases and Blood Diseases

Legg-Calvé-Perthes Disease and Risks for Cardiovascular Diseases and Blood Diseases

Deprivation, urbanisation and Perthes’ disease in Northern Ireland

Unravelling the enigma of Perthes disease

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