Malleson P N, Fung M Y, Rosenberg A M
Department of Pediatrics, University of British Columbia, Alberta, Canada.
J Rheumatol. 1996 Nov;23(11):1981-7.
To determine the incidence of rheumatic diseases in children, and the frequency of musculoskeletal disorders seen by pediatric rheumatology specialists in Canada.
Applying standardized disease definitions and disease codes modified from ICD-9, members of the Canadian Pediatric Rheumatology Association from 13 centers in all 10 provinces of Canada registered all new patients seen between May 1, 1991 and April 30, 1993. Patient data included age, sex, ethnicity, date of birth, date of disease onset, date of diagnosis, and diagnostic codes (more than one diagnosis could be entered). To minimize the bias of right censoring, only data from patients with disease onset between May 1, 1991 and October 31, 1992 were used to estimate disease incidence.
3362 records totalling 3683 diagnoses (92 separate diagnoses) were registered. Median referral rate per year to a pediatric rheumatology center was 26 per 100,000 children at risk. The frequency of diseases seen was 23.3% for all forms of chronic arthritis, 6.5% for connective tissue diseases, and 6.1% for all forms of vasculitis. The minimum incidence rates per 100,000 children at risk per year calculated from the whole registry were: all forms of chronic arthritis 4.08 (95% CI: 3.62, 4.60), systemic lupus erythematosus 0.28 (0.18, 0.45), and dermatomyositis 0.15 (0.09, 0.29). Substantially higher figures were obtained if the figures were calculated excluding the 2 provinces (Alberta and Quebec) that had disproportionately low referral rates.
Pediatric rheumatologists see children with a wide variety of diseases. It is important that pediatric rheumatology training reflects this and does not focus exclusively on the classical inflammatory arthropathies. The minimum incidence data show there are substantial numbers of children developing potentially lifelong chronic rheumatic diseases each year in Canada. These data should be helpful in planning the delivery of pediatric rheumatology services not only in Canada, but also in other developed countries.
确定加拿大儿童风湿性疾病的发病率以及儿科风湿病专家诊治的肌肉骨骼疾病的发生频率。
加拿大儿科风湿病协会的成员来自加拿大10个省的13个中心，他们采用从ICD - 9修改而来的标准化疾病定义和疾病编码，对1991年5月1日至1993年4月30日期间诊治的所有新患者进行登记。患者数据包括年龄、性别、种族、出生日期、疾病发病日期、诊断日期和诊断编码（可输入不止一个诊断）。为尽量减少右侧截尾的偏差，仅使用1991年5月1日至1992年10月31日发病患者的数据来估计疾病发病率。
共登记了3362份记录，总计3683个诊断（92种不同诊断）。每年转诊至儿科风湿病中心的中位转诊率为每10万名有患病风险的儿童中有26例。各类疾病的发生频率为：所有类型的慢性关节炎占23.3%，结缔组织病占6.5%，所有类型的血管炎占6.1%。根据整个登记数据计算出的每年每10万名有患病风险儿童的最低发病率为：所有类型的慢性关节炎4.08（95%可信区间：3.62，4.60），系统性红斑狼疮0.28（0.18，0.45），皮肌炎0.15（0.09，0.29）。如果计算时排除转诊率极低的两个省份（艾伯塔省和魁北克省），则得出的数字要高得多。
儿科风湿病专家诊治患有多种疾病的儿童。重要的是，儿科风湿病学培训应反映这一点，而不应仅专注于经典的炎性关节病。最低发病率数据表明，加拿大每年有大量儿童患上可能会影响终身的慢性风湿性疾病。这些数据不仅有助于加拿大规划儿科风湿病服务的提供，也有助于其他发达国家。
