Division of Endocrinology, Department of Medicine 1, University Hospital, Goethe-University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
Eur J Endocrinol. 2014 Feb 4;170(3):367-73. doi: 10.1530/EJE-13-0756. Print 2014 Mar.
Our objective was to investigate the epidemiology of autoimmune Addison's disease (AD) in Germany.
Routine data were analyzed from the Statutory Health Insurance (SHI) database of the Techniker Krankenkasse (TK) for an observation period from 01/01/2008 to 31/12/2012. The TK is one of the largest German health care insurance providers covering more than 10% of the German population.
Between 2008 and 2012, a total of 2477 diagnoses of primary adrenal failure were recorded in the SHI database. After exclusion of secondary, iatrogenic or other non-idiopathic forms and after adjustment for incomplete data sets, 1364 diagnoses of autoimmune-mediated AD remained.
The prevalence of AD in our cohort showed a steady increase from 82 per million in 2008 to 87 per million in 2012. On average, the prevalence rose about 1.8% per year, and due to a pronounced increase (2.7%) in females. The prevalence was lower in men (63-68 per million) than in women (96-108 per million). Autoimmune comorbidities were found in 46.5% of AD patients. Adrenal crises were documented with a frequency of 14-17/100 patient years.
These data provide a first epidemiological profile of this rare and perilous endocrine disease in Germany. Although the prevalence of AD appears lower than in the Scandinavian countries, the increasing figures in females over the last 5 years warrant further investigations. Furthermore, adrenal crises pose a considerable burden. Hereby, we can show that health insurance data provide a valuable tool for epidemiological studies in the absence of national registries.
我们旨在研究德国自身免疫性艾迪生病（Addison's disease，AD）的流行病学。
对 Techniker Krankenkasse（TK）法定健康保险（Statutory Health Insurance，SHI）数据库中的常规数据进行分析，观察期为 2008 年 1 月 1 日至 2012 年 12 月 31 日。TK 是德国最大的医疗保险提供商之一，覆盖了超过 10%的德国人口。
2008 年至 2012 年间，在 SHI 数据库中记录了总共 2477 例原发性肾上腺功能衰竭的诊断。在排除了继发性、医源性或其他非特发性形式，并对不完整的数据集进行调整后，剩下 1364 例自身免疫介导的 AD 诊断。
我们队列中的 AD 患病率呈稳步上升趋势，从 2008 年的每百万 82 例上升到 2012 年的每百万 87 例。平均而言，患病率每年上升约 1.8%，这主要是由于女性的显著上升（2.7%）。男性的患病率（每百万 63-68 例）低于女性（每百万 96-108 例）。在 AD 患者中发现了 46.5%的自身免疫合并症。记录到肾上腺危象的频率为每 100 例患者年 14-17 例。
这些数据提供了德国这一罕见且危险的内分泌疾病的首个流行病学特征。尽管 AD 的患病率似乎低于斯堪的纳维亚国家，但过去 5 年女性患病率的上升趋势值得进一步调查。此外，肾上腺危象带来了相当大的负担。通过这些数据，我们可以证明在没有国家登记的情况下，健康保险数据是进行流行病学研究的有价值工具。
