Kim Kyoung Jin, Baek Seungjin, Yu Min Heui, Shin Sungjae, Cho Sungjoon, Rhee Yumie, Hong Namki
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea.
Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
JBMR Plus. 2024 May 13;8(7):ziae065. doi: 10.1093/jbmrpl/ziae065. eCollection 2024 Jul.
Data on epidemiology and secular trend in primary hyperparathyroidism (PHPT) in adults are relatively limited in Asian countries. This study aims to provide an overview of the secular trends in incidence, clinical characteristics, and treatment patterns of PHPT in South Korea. We used Korea's National Health Insurance Claim database (2005-2020) to identify newly diagnosed PHPT cases. Individuals with age below 19, fewer than 2 E21.0 diagnoses, fewer than 2 PTH measurements, secondary hyperparathyroidism, undergoing dialysis or kidney transplantation within a year of diagnosis, parathyroidectomy (PTX) within a year prior to the diagnosis code, and diagnosis of multiple endocrine neoplasm or parathyroid carcinoma were excluded from the analysis. A total of 6837 patients with PHPT (PTX, = 2989; non-surgery, = 3848) were compared with 1:10 age- and sex-matched controls ( = 68 370). The mean age of patients with PHPT was 56.0 years, with 77.4% being women. The annual incidence of PHPT increased from 0.23/100 000 persons in 2005 to 1.75 in 2020, with higher rate in women than in men. Compared with 2005-2010 ( = 675), the number of newly diagnosed PHPT cases increased up to 3.1-fold ( = 2119) in 2011-2015 and 6.0-fold ( = 4043) in 2016-2020 periods. Among all patients with PHPT, 43.7% of patients underwent PTX, with decrement of proportion of bilateral surgery among PTX group across time (11.9% in 2005-2010 to 8.9% in 2016-2020, for trend .033). Among all patients with PHPT, non-surgery group increased from 41.6% in 2005-2010 to 58.0% in 2016-2020 ( for trend <.001). Patients with PHPT had higher odds of osteoporosis (odds ratio [OR] 7.03), renal stones (OR 10.55), chronic kidney diseases (OR 7.42), and cardiovascular, metabolic, and neurological conditions after adjustment for comorbidity index. In summary, the incidence of PHPT increased from 2005 to 2020 with predominance of non-surgical treatment, which calls for research focus on improving non-surgical management.
在亚洲国家，关于成人原发性甲状旁腺功能亢进症（PHPT）的流行病学和长期趋势的数据相对有限。本研究旨在概述韩国PHPT的发病率、临床特征和治疗模式的长期趋势。我们使用韩国国民健康保险索赔数据库（2005 - 2020年）来识别新诊断的PHPT病例。年龄低于19岁、E21.0诊断少于2次、甲状旁腺激素（PTH）测量少于2次、继发性甲状旁腺功能亢进、在诊断后一年内接受透析或肾移植、在诊断编码前一年内接受甲状旁腺切除术（PTX）以及诊断为多发性内分泌肿瘤或甲状旁腺癌的个体被排除在分析之外。总共6837例PHPT患者（PTX组，n = 2989；非手术组，n = 3848）与年龄和性别匹配的1:10对照组（n = 68370）进行比较。PHPT患者的平均年龄为56.0岁，其中77.4%为女性。PHPT的年发病率从2005年的0.23/10万人增加到2020年的1.75/10万人，女性发病率高于男性。与2005 - 2010年（n = 675）相比，2011 - 2015年新诊断的PHPT病例数增加到3.1倍（n = 2119），2016 - 2020年增加到6.0倍（n = 4043）。在所有PHPT患者中，43.7%的患者接受了PTX，PTX组中双侧手术的比例随时间下降（2005 - 2010年为11.9%，2016 - 2020年为8.9%，趋势P = 0.033）。在所有PHPT患者中，非手术组从2005 - 2010年的41.6%增加到2016 - 2020年的58.0%（趋势P < 0.001）。在调整合并症指数后，PHPT患者患骨质疏松症（优势比[OR] 7.03）、肾结石（OR 10.55）、慢性肾脏病（OR 7.42）以及心血管、代谢和神经疾病的几率更高。总之，2005年至2020年PHPT的发病率上升，非手术治疗占主导，这需要将研究重点放在改善非手术管理上。
