The Epidemiology of Antiphospholipid Syndrome: A Population‐Based Study

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Abstract

To estimate the incidence, prevalence and mortality of antiphospholipid syndrome (APS). An inception cohort of patients with incident APS in 2000-2015 in a geographically well-defined population was identified based on comprehensive individual medical record review. All cases met the 2006 Sydney APS criteria (primary definition) or had APS by physician consensus (secondary definition). Lupus anticoagulant, IgM and IgG aCL and anti-β2 glycoprotein-1 antibodies were tested in a centralized lab. Incidence rates were age- and sex-adjusted to the US white 2010 population. Prevalence estimates were obtained from the incidence rates assuming no increased mortality associated with APS and assuming migration in/out of the area was independent of disease status. In 2000-2015, 33 cases of incident APS by the Sydney criteria were identified (mean age 54.2 years, 55% female; 97% Caucasian). The annual incidence of APS was 2.1 (95% confidence interval [CI]: 1.4-2.8) per 100,000 population aged ≥ 18 years. Incidence rates were similar in both sexes. The estimated prevalence of APS was 50 per 100,000 (95% CI: 42-58) and was similar in both sexes. Six (18%) patients had a concurrent diagnosis of systemic lupus erythematosus. The most frequent clinical manifestation was deep venous thrombosis. The overall mortality of patients with APS was not significantly different from the general population (standardized mortality ratio: 1.61; 95% CI: 0.74-3.05). APS occurred in about 2 persons per 100,000 per year. The estimated prevalence is 50 per 100,000. Overall mortality was not different from the general population.

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Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007.

Elena Myasoedova, Cynthia Crowson, Hilal Kremers … (2010)

To examine trends in the incidence and prevalence of rheumatoid arthritis (RA) from 1995 to 2007. To augment our preexisting inception cohort of patients with RA (1955-1994), we assembled a population-based incidence cohort of individuals >or=18 years of age who first fulfilled the American College of Rheumatology 1987 criteria for the classification of RA between January 1, 1995 and December 31, 2007 and a cohort of patients with prevalent RA on January 1, 2005. Incidence and prevalence rates were estimated and were age-and sex-adjusted to the white population in the US in 2000. Trends in incidence rates were examined using Poisson regression methods. The 1995-2007 incidence cohort comprised 466 patients (mean age 55.6 years), 69% of whom were female and 66% of whom were rheumatoid factor positive. The overall age- and sex-adjusted annual RA incidence was 40.9/100,000 population. The age-adjusted incidence in women was 53.1/100,000 population (versus 27.7/100,000 population in men). During the period of time from 1995 to 2007, the incidence of RA increased moderately in women (P = 0.02) but not in men (P = 0.74). The increase was similar among all age groups. The overall age- and sex-adjusted prevalence on January 1, 2005 was 0.72% (95% confidence interval [95% CI] 0.66, 0.77), which is an increase when compared with a prevalence of 0.62% (95% CI 0.55, 0.69) in 1995 (P < 0.001). Applying the prevalence on January 1, 2005 to the US population in 2005 showed that an estimated 1.5 million US adults were affected by RA. This is an increase from the previously reported 1.3 million adults with RA in the US. The incidence of RA in women appears to have increased during the period of time from 1995 to 2007. The reasons for this recent increase are unknown, but environmental factors may play a role. A corresponding increase in the prevalence of RA was also observed.

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Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project.

Jennifer St. Sauver, Brandon R. Grossardt, Cynthia Leibson … (2012)

To illustrate the problem of generalizability of epidemiological findings derived from a single population using data from the Rochester Epidemiology Project and from the US Census. We compared the characteristics of the Olmsted County, Minnesota, population with the characteristics of populations residing in the state of Minnesota, the Upper Midwest, and the entire United States. Age, sex, and ethnic characteristics of Olmsted County were similar to those of the state of Minnesota and the Upper Midwest from 1970 to 2000. However, Olmsted County was less ethnically diverse than the entire US population (90.3% vs 75.1% white), more highly educated (91.1% vs 80.4% high school graduates), and wealthier ($51,316 vs $41,994 median household income; 2000 US Census data). Age- and sex-specific mortality rates were similar for Olmsted County, the state of Minnesota, and the entire United States. We provide an example of analyses and comparisons that may guide the generalization of epidemiological findings from a single population to other populations or to the entire United States. Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester epidemiology project.

Walter A Rocca, Barbara P. Yawn, L. Joseph Melton … (2011)

The Rochester Epidemiology Project (REP) is a unique research infrastructure in which the medical records of virtually all persons residing in Olmsted County, Minnesota, for over 40 years have been linked and archived. In the present article, the authors describe how the REP links medical records from multiple health care institutions to specific individuals and how residency is confirmed over time. Additionally, the authors provide evidence for the validity of the REP Census enumeration. Between 1966 and 2008, 1,145,856 medical records were linked to 486,564 individuals in the REP. The REP Census was found to be valid when compared with a list of residents obtained from random digit dialing, a list of residents of nursing homes and senior citizen complexes, a commercial list of residents, and a manual review of records. In addition, the REP Census counts were comparable to those of 4 decennial US censuses (e.g., it included 104.1% of 1970 and 102.7% of 2000 census counts). The duration for which each person was captured in the system varied greatly by age and calendar year; however, the duration was typically substantial. Comprehensive medical records linkage systems like the REP can be used to maintain a continuously updated census and to provide an optimal sampling framework for epidemiologic studies.