Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, CF14 4XN, U.K.
Pharmatelligence, Cardiff, CF14 3QX, U.K.
Br J Dermatol. 2018 Apr;178(4):917-924. doi: 10.1111/bjd.16101. Epub 2018 Feb 22.
Epidemiology data regarding hidradenitis suppurativa (HS) are conflicting and prevalence estimates vary 80-fold, from 0·05% in a population-based study to 4%.
To assess the hypothesis that previous population-based studies underestimated true HS prevalence by missing undiagnosed cases.
We performed a population-based observational and case-control study using the U.K. Clinical Practice Research Datalink (CPRD) linked to hospital episode statistics data. Physician-diagnosed cases in the CPRD were identified from specific Read codes. Algorithms identified unrecognized 'proxy' cases, with at least five Read code records for boils in flexural skin sites. Validation of proxy cases was undertaken with general practitioner (GP) questionnaires to confirm criteria-diagnosed cases. A case-control study assessed disease associations.
On 30 June 2013, 23 353 physician-diagnosed HS cases were documented in 4 364 308 research-standard records. In total, 68 890 proxy cases were identified, reduced to 10 146 criteria-diagnosed cases after validation, extrapolated from 107 completed questionnaires (61% return rate). Overall point prevalence was 0·77% [95% confidence interval (CI) 0·76-0·78%]. An additional 18 417 cases had a history of one to four flexural skin boils. In physician-diagnosed cases, odds ratios (ORs) for current smoker and obesity (body mass index > 30 kg m ) were 3·61 (95% CI 3·44-3·79) and 3·29 (95% CI 3·14-3·45). HS was associated with type 2 diabetes, Crohn disease, hyperlipidaemia, acne and depression, and not associated with ulcerative colitis or polycystic ovary syndrome.
Contrary to results of previous population-based studies, HS is relatively common, with a U.K. prevalence of 0·77%, one-third being unrecognized, criteria-diagnosed cases using the most stringent disease definition. If individuals with probable cases are included, HS prevalence rises to 1·19%.
有关化脓性汗腺炎（HS）的流行病学数据存在争议，患病率估计值差异高达 80 倍，从基于人群的研究中的 0.05%到 4%不等。
评估先前基于人群的研究通过漏诊未确诊病例低估了真实 HS 患病率的假设。
我们使用英国临床实践研究数据链接（CPRD）与医院发病统计数据进行了一项基于人群的观察性病例对照研究。CPRD 中的医生诊断病例是从特定的 Read 代码中确定的。算法确定了至少有五个用于弯曲皮肤部位脓肿的 Read 代码记录的未被识别的“代理”病例。通过全科医生（GP）问卷对代理病例进行验证，以确认符合标准的诊断病例。病例对照研究评估了疾病相关性。
截至 2013 年 6 月 30 日，在 4364308 份研究标准记录中记录了 23353 例医生诊断的 HS 病例。总共确定了 68890 例代理病例，经过验证后减少到 10146 例符合标准的诊断病例，这是从 107 份完整问卷中推断出来的（61%的回复率）。总体点患病率为 0.77%[95%置信区间（CI）0.76-0.78%]。另有 18417 例患者有一到四个弯曲皮肤脓肿的病史。在医生诊断的病例中，当前吸烟者和肥胖症（体重指数>30kg/m2）的比值比（OR）分别为 3.61（95%CI 3.44-3.79）和 3.29（95%CI 3.14-3.45）。HS 与 2 型糖尿病、克罗恩病、血脂异常、痤疮和抑郁症有关，与溃疡性结肠炎或多囊卵巢综合征无关。
与先前基于人群的研究结果相反，HS 相对常见，英国的患病率为 0.77%，其中三分之一为未被识别的符合最严格疾病定义的诊断病例。如果包括可能的病例，HS 的患病率上升至 1.19%。
