Giggs J A, Bourke J B, Katschinski B
Department of Geography, University Hospital, Nottingham University, England.
Soc Sci Med. 1988;26(1):79-89. doi: 10.1016/0277-9536(88)90047-0.
In most countries primary acute pancreatitis is a rare disease. However, its incidence has been increasing for several decades and many patients do not survive their first attack. During the 15 years (1969-83) 493 patients with the disease were admitted to Nottingham's two District General Hospitals. The geographical distribution of the disease within the study area was determined using 62 electoral wards and two patient cohorts namely 214 1969-76 admissions (1971 census base) and 279 1977-83 admissions (1981 census base). The incidence of the disease increased from 27 per annum to 40 per annum in the two cohorts. Most of the alcohol associated patients (18 first cohort: 38 second cohort) were young or middle aged males. For gallstone and 'non-gallstone' associated groups the incidence rose sharply with increasing age for both sexes. For both cohorts there were large statistically significant variations in the distribution of pancreatitis within the study area. Moreover, the spatial distribution was very similar for both cohorts with most of the highest rate wards clustering in a U-shaped area east of the city centre. Investigation of environmental factors suggested that this high-rate area coincides with the region served by the Burton Joyce domestic drinking water supply. Examination of the residential histories of the 493 patients showed that 25.6% had moved home less than five years prior to their first attack. Analysis of these moves confirmed that many patients had moved to suburban areas from two major inner city housing renewal schemes located within the high-rate Burton Joyce water supply area. Re-calculation of incidence rates of pancreatitis by former address for the six water supply areas established that only the Burton Joyce area had significantly high numbers of cases for both cohorts.
在大多数国家，原发性急性胰腺炎是一种罕见疾病。然而，几十年来其发病率一直在上升，许多患者在首次发病时未能存活。在1969年至1983年的15年间，诺丁汉的两家地区综合医院收治了493例该疾病患者。利用62个选区病房以及两个患者队列（即1969年至1976年入院的214例患者[以1971年人口普查数据为基础]和1977年至1983年入院的279例患者[以1981年人口普查数据为基础]）确定了研究区域内该疾病的地理分布。两个队列中该疾病的发病率从每年27例增至每年40例。大多数与酒精相关的患者（第一队列18例，第二队列38例）为青年或中年男性。对于胆结石及“非胆结石”相关组，男女发病率均随年龄增长而急剧上升。两个队列在研究区域内胰腺炎的分布均存在统计学上的显著差异。此外，两个队列的空间分布非常相似，大多数高发病率病房集中在市中心以东的一个U形区域。对环境因素的调查表明，这个高发病率区域与伯顿乔伊斯家庭饮用水供应所覆盖的区域一致。对493例患者居住史的调查显示，25.6%的患者在首次发病前不到五年搬过家。对这些搬家情况的分析证实，许多患者是从位于高发病率的伯顿乔伊斯供水区域内的两个主要市中心内城房屋更新计划区域搬到了郊区。根据六个供水区域患者的以前住址重新计算胰腺炎发病率后发现，只有伯顿乔伊斯地区两个队列的病例数均显著偏高。
