Le Moal Joëlle, Rigou Annabel, Le Tertre Alain, De Crouy-Channel Perrine, Léger Juliane, Carel Jean-Claude
Environmental Health Division, Santé publique France, Saint-Maurice, France.
PROTECT, INSERM, Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France.
Eur J Endocrinol. 2018 Jan;178(1):33-41. doi: 10.1530/EJE-17-0379. Epub 2017 Sep 10.
Precocious puberty seems to be increasing but epidemiological data are scarce. Our objective was to improve the epidemiologic knowledge on this disease. We analyzed the national incidence and spatial trends of idiopathic central precocious puberty in France in 2011-2013 in a cross-sectional descriptive study.
We used an indicator based on treatment reimbursements recorded in the national insurance database, in girls under the age of nine years and in boys under the age of 10 years. We considered a time lag of up to one year from the onset of puberty to first drug delivery. We tested four different predictive spatial models at the scale, selecting the model best fitting the data. We carried out semi-structured interviews with qualified hospital teams in five selected regions to investigate spatial differences in medical practices.
The national annual incidence was 2.68 (95% CI: 2.55, 2.81) per 10 000 girls under the age of 9 years and 0.24 (95% CI: 0.21, 0.27) per 10 000 boys under the age of 10 years. Incidence rates conformed to a purely spatial heterogeneity model in girls, consistent between age groups, with a large incidence range. A similar pattern was observed for boys, with peaks in the South West and Center East. Differences in medical practices may have slightly affected incidence locally, but could not entirely explain the marked geographic pattern.
The results suggest that the risk factors are similar for boys and girls and justify further investigations of the role of the environment.
性早熟的发病率似乎在上升，但流行病学数据却很匮乏。我们的目标是增进对这种疾病的流行病学认识。在一项横断面描述性研究中，我们分析了2011 - 2013年法国特发性中枢性性早熟的全国发病率及空间趋势。
我们使用了基于国家保险数据库中记录的治疗报销情况的指标，对象为9岁以下女孩和10岁以下男孩。我们考虑了从青春期开始到首次给药长达一年的时间间隔。我们在区域尺度上测试了四种不同的预测空间模型，选择最适合数据的模型。我们对五个选定地区的合格医院团队进行了半结构化访谈，以调查医疗实践中的空间差异。
全国每年每10000名9岁以下女孩的发病率为2.68（95%可信区间：2.55，2.81），每10000名10岁以下男孩的发病率为0.24（95%可信区间：0.21，0.27）。女孩的发病率符合纯空间异质性模型，各年龄组之间一致，发病率范围较大。男孩也观察到类似模式，在西南部和中东地区出现峰值。医疗实践的差异可能在局部对发病率有轻微影响，但不能完全解释明显的地理模式。
结果表明，男孩和女孩的危险因素相似，这为进一步研究环境的作用提供了依据。
