Population based epidemiology of amyotrophic lateral sclerosis using capture-recapture methodology
Population based epidemiology of amyotrophic lateral sclerosis using capture-recapture methodology
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DOI：
10.1136/jnnp.2011.244939
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发表时间：
2011-10-01
影响因子：
11
通讯作者：
van den Berg, Leonard H.
中科院分区：
文献类型：
--
作者：
Huisman, Mark H. B.;de Jong, Sonja W.;van den Berg, Leonard H.
背景肌萎缩侧索硬化症(ALS)流行病学研究中发病率的差异可能是由于人群规模较小和患者不确定所致。方法对2006年1月1日至2009年12月31日在荷兰大规模人群登记的ALS流行病学进行了研究，并在不同的年龄和性别组中应用捕获-再捕获方法以调整未观察到的患者的数量。结果观察到1217例发病患者，捕获-再捕获发生率为2.77/10万人年(95%可信区间为2.63~2.91)。2008年12月31日的流行率为每10万人10.32人(95%可信区间为9.78至10.86)。与流行的队列相比，发病队列的发病年龄中位数更高(63.0岁比58.1岁)，球部发病的患者更多(30.0%比19.1%)。发病率和患病率在70-74岁年龄组达到顶峰，随后在老年迅速下降。绝经前年龄组男女比例(1.91，95%CI 1.32~2.79)与绝经后年龄组(1.50，95%CI 1.34~1.67)比较差异无统计学意义(P>0.05)。老年人发病率的下降可能表明ALS不仅仅是衰老的结果。绝经后男女比例没有明显下降，这表明女性性激素在ALS中的保护作用是有限的。
Background Variation in the incidence rate in epidemiological studies on amyotrophic lateral sclerosis (ALS) may be due to a small population size and under ascertainment of patients. The previously reported incidence decline in the elderly and a decrease in the male: female ratio in postmenopausal age groups have yet to be confirmed.Methods ALS epidemiology in a large population based register in The Netherlands was studied between 1 January 2006 and 31 December 2009, and applied capture-recapture methodology in separate age and gender groups to adjust for the number of unobserved patients.Results 1217 incident patients were observed, and a capture-recapture incidence of 2.77 per 100 000 person-years (95% CI 2.63 to 2.91). Prevalence on 31 December 2008 was 10.32 per 100 000 individuals (95% CI 9.78 to 10.86). The incident cohort had a higher median age at onset (63.0 vs 58.1 years) and more bulbar onset patients (30.0% vs 19.1%) compared with the prevalent cohort. Incidence and prevalence peaked in the 70-74 year age group followed by a rapid decline in older age. The male: female ratio in the premenopausal age group (1.91, 95% CI 1.32 to 2.79) was not significantly higher than that in the postmenopausal age group (1.50, 95% CI 1.34 to 1.67).Conclusion The marked difference in patient characteristics between incident and prevalent cohorts underscores the importance of including incident patients when studying susceptibility or disease modifying factors in ALS. The incidence decline in the elderly may suggest that ALS is not merely the result of ageing. Absence of a significant postmenopausal drop in the male: female ratio suggests that the protective role of female sex hormones in ALS is limited.