Unit of Biostatistics, Epidemiology and Public Health Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy.
Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy.
Int J Environ Res Public Health. 2021 Jul 5;18(13):7175. doi: 10.3390/ijerph18137175.
Diagnosis of endometriosis and evaluation of incidence data are complex tasks because the disease is identified laparoscopically and confirmed histologically. Incidence estimates reported in literature are widely inconsistent, presumably reflecting geographical variability of risk and the difficulty of obtaining reliable data.
We retrieved incident cases of endometriosis in women aged 15-50 years using hospital discharge records and pathology databases of the Friuli Venezia Giulia region in the calendar period 2004-2017. We studied the spatial pattern of endometriosis incidence applying Bayesian approaches to Disease Mapping, and profiled municipalities at higher risk controlling for multiple comparisons using both q-values and a fully Bayesian approach.
4125 new cases of endometriosis were identified in the age range 15 to 50 years in the period 2004-2017. The incidence rate (x100 000) is 111 (95% CI 110-112), with a maximum of 160 in the age group 31-35 years. The geographical distribution of endometriosis incidence showed a very strong north-south spatial gradient. We consistently identified a group of five neighboring municipalities at higher risk (RR 1.31 95% CI 1.13; 1.52), even accounting for ascertainment bias.
The cluster of 5 municipalities in the industrialized and polluted south-east part of the region is suggestive. However, due to the ecologic nature of the present study, information on the patients' characteristics and exposure histories are limited. Individual studies, including biomonitoring, and life-course studies are necessary to better evaluate our findings.
子宫内膜异位症的诊断和发病率数据评估是复杂的任务，因为该疾病是通过腹腔镜检查和组织学确认来确定的。文献中报告的发病率估计值差异很大，这可能反映了风险的地域差异和获得可靠数据的困难。
我们使用医院出院记录和 Friuli Venezia Giulia 地区的病理数据库，检索了 2004-2017 年间年龄在 15-50 岁的女性的子宫内膜异位症新发病例。我们应用疾病映射的贝叶斯方法研究了子宫内膜异位症发病率的空间模式，并通过 q 值和完全贝叶斯方法控制多次比较，对风险较高的市政当局进行了概况分析。
在 2004-2017 年期间，年龄在 15 至 50 岁之间的女性中，共发现 4125 例新发病例。发病率（x100000）为 111（95%CI 110-112），年龄组 31-35 岁的发病率最高，为 160。子宫内膜异位症发病率的地理分布显示出非常强烈的南北空间梯度。我们一致确定了一组五个相邻的高风险市政当局（RR 1.31 95%CI 1.13；1.52），即使考虑到确证偏倚。
该地区东南部工业化和污染地区的 5 个市政当局集群很有提示性。然而，由于本研究的生态性质，患者特征和暴露史的信息有限。需要进行包括生物监测和生命历程研究在内的个体研究，以更好地评估我们的发现。
