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

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

doi:10.1136/archdischild-2012-302143

Cited by 25 publications

(24 citation statements)

References 15 publications

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“…ADHD and LCPD share common risk factors through inheritance or exposure, such as deprivation (Lingineni et al 2012, Perry et al 2012b), higher injury risk (Maxson et al 2009, Hailer et al 2012), and maternal and passive smoking (Garcia Mata et al 2000, Button et al 2005). Especially in adults, neurobehavioral aspects of ADHD can change from hyperactivity to more inattentiveness or depression (Yang et al 2013), which may explain the higher risk of depression in individuals with LCPD than in their controls, and which also supports our hypothesis (2).…”

Section: Discussionmentioning

confidence: 99%

Legg-Calvé-Perthes disease and the risk of ADHD, depression, and mortality

Hailer¹,

Nilsson²

2014

Acta Orthopaedica

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Background and purpose Hyperactive behavior pattern (such as attention deficit hyperactivity disorder (ADHD)) is proposed to be present in individuals with Legg-Calvé-Perthes disease (LCPD). We investigated whether individuals with LCPD have a higher risk of ADHD, depression, and mortality.Subjects and methods We identified 4,057 individuals with LCPD in Sweden during the period 1964–2011. 40,570 individuals without LCPD were randomly selected from the Swedish general population and matched by year of birth, sex, and region (control group). We used Cox proportional hazard regression to estimate the relative risks.Results Compared to the control group, individuals with LCPD had a raised hazard ratio (HR) of 1.5 (95% CI: 1.2–1.9) for ADHD. The risks were higher for female individuals (HR = 2.1, CI: 1.3–3.5) than for male individuals (HR = 1.4, CI: 1.1–1.8). Individuals with LCPD had a modestly higher hazard ratio for depression (HR = 1.3, CI: 1.1–1.5) than the control group. Furthermore, individuals with LCPD had a slightly higher mortality risk than the control group (HR = 1.2, CI: 1.0–1.4)Interpretation Individuals with LCPD have a higher risk of ADHD. Hyperactivity could expose the femoral head to higher mechanical stress and contribute to the etiology of LCPD. The higher risk of depression may be due to the burden of LCPD itself or could reflect neurobehavioral aspects of ADHD changing into depression later in life. Individuals with LCPD have a higher mortality risk, with higher risk of suicide and cardiovascular diseases.

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Section: Discussionmentioning

confidence: 99%

Legg-Calvé-Perthes disease and the risk of ADHD, depression, and mortality

Hailer¹,

Nilsson²

2014

Acta Orthopaedica

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“…Data concerning Perthes disease discharges in Scotland 21 and unpublished data from the Perthes disease register from Northern Ireland (presented at the British Orthopaedic Association congress in 2012) have similarly confirmed a decline in Perthes disease incidence, adding support to the validity and generalisability of these findings.…”

Section: The Urban Environmentmentioning

confidence: 78%

“…Perthes disease discharge data from Scotland were used in 2012 to investigate this relationship. 21 Scotland is a particularly good setting for this investigation as it is largely rural despite having a number of major cities and some of the UK's most deprived areas. This study observed more Perthes disease in urban environments.…”

Section: The Urban Environmentmentioning

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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“…In the UK, a decline in incidence of the disease has been described, particularly in more deprived areas (Perry et al. 2012b). …”

mentioning

confidence: 99%

“…In a more recent study using data from the Scottish Morbidity Record for the period 2000–2010, the occurrence of Perthes’ disease after stratification for socioeconomic deprivation showed similar rates in urban and rural areas of Scotland (Perry et al. 2012b). …”

mentioning

confidence: 99%

Incidence of Perthes’ disease in children born between 1973 and 1993

et al. 2016

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Background and purpose — The incidence of Perthes’ disease as reported in the literature varies widely between and within countries. The etiology of the disease is still unknown. Both environmental and genetic factors have been suggested to play a part in either causing the disease or increasing the susceptibility of an individual. We determined the incidence of Perthes’ disease in Sweden and investigated possible relationships to parental socioeconomic status, ethnicity, marital status, mothers’ age when giving birth, parity, number of siblings, and smoking habits.Patients and methods — Six Swedish population-based registers were used, together covering all children born in Sweden from 1973 through 1993.Results — The incidence of Perthes’ disease in Sweden was 9.3 per 100,000 subjects. The ratio between boys and girls was 3.1:1. The educational level of the father and the mother of a child with Perthes’ disease was lower than in the controls. The incidence was lower when the fathers were in the highest income bracket (above the 90th percentile). A higher proportion of parents of Nordic lineage had children with Perthes’ disease than parental pairs with one or both who were not of such lineage.Interpretation — This study confirms that there is an association between the incidence of Perthes’ disease and the socioeconomic status of the parents.

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

Cited by 25 publications

References 15 publications

Legg-Calvé-Perthes disease and the risk of ADHD, depression, and mortality

Legg-Calvé-Perthes disease and the risk of ADHD, depression, and mortality

Unravelling the enigma of Perthes disease

Incidence of Perthes’ disease in children born between 1973 and 1993

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