Rheumatology 2000; 39: 1396-1402
© 2000 British Society for Rheumatology
Giant cell arteritis is more prevalent in urban than in rural populations: results of an epidemiological study of primary systemic vasculitides in Germany
Department of Rheumatology, University of Lübeck and Rheumaklinik Bad Bramstedt GmbH
1 Department of Rheumatology and Clinical Immunology, University of Freiburg and
2 Department of Social Medicine, University of Lübeck, Germany
Objective. To investigate the period prevalences of primary systemic vasculitides (PSV) in urban and rural populations in northern and southern Germany in 1994.
Methods. Questionnaires were sent to all hospital departments, all physicians, health insurance providers and pension funds, reference laboratories for autoimmune diseases, and death registries in two catchment areas in northern and southern Germany (combined population 875 983) to identify patients with PSV between 1 January and 31 December 1994. Each catchment area encompassed both an urban and a rural area. Each case was re-evaluated by the authors by applying the definitions of the 1992 Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis.
Results. A total of 180 PSV patients were identified. The overall prevalence of PSV was 216 cases per 1 000 000 inhabitants (95% confidence interval (CI) 173–259) in northern Germany vs 195 (95% CI 153–236) in southern Germany. The prevalence of PSV was two-fold higher in women than in men, and five-fold higher in people aged 
50 yr than in people aged <50 yr. The most frequent type of PSV was giant cell arteritis (GCA), with 87 cases per 1 000 000 in northern and 94 in southern Germany, followed by Wegener's granulomatosis, with 58 and 42 cases respectively. In the population aged 50 yr the prevalence of GCA was 240 per 1 000 000 in northern and 300 in southern Germany. In both northern and southern Germany the prevalence of GCA in this older population was significantly higher in urban than in rural populations (355 per 1 000 000 vs 115 in northern Germany (P<0.01) and 395 vs 220 (P<0.05) in southern Germany). The relative risk for the older urban population having GCA was 2.25-fold higher (95% CI 1.4–3.6) than in the rural population, and for the female population it was 4.7-fold higher in the urban than in the rural areas (95% CI 2.4–9.3).
Conclusion. In both northern and southern Germany, GCA was significantly more prevalent in urban than in rural populations, especially among people aged 50 yr and in women. It remains unclear whether this disparity was due to underdiagnosis of GCA in the rural regions associated with differences in the German health-care system in cities vs rural areas. Further studies must examine the role of (chronic) exposure to the environmental factors characteristic of cities.
KEY WORDS: Epidemiology, Vasculitis, Giant cell arteritis, Wegener's granulomatosis.
Correspondence to: E. Reinhold-Keller, Poliklinik für Rheumatologie der Universität zu Lübeck, Rheumaklinik Bad Bramstedt GmbH, Oskar-Alexander-Strasse 26, D-24576 Bad Bramstedt, Germany.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. J. Mohammad, L. T. H. Jacobsson, A. D. Mahr, G. Sturfelt, and M. Segelmark Prevalence of Wegener's granulomatosis, microscopic polyangiitis, polyarteritis nodosa and Churg Strauss syndrome within a defined population in southern Sweden Rheumatology, August 1, 2007; 46(8): 1329 - 1337. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.E. Lane, R.A. Watts, L. Shepstone, and D.G.I. Scott Primary systemic vasculitis: clinical features and mortality QJM, February 1, 2005; 98(2): 97 - 111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Reinhold-Keller, K. Herlyn, R. Wagner-Bastmeyer, J. Gutfleisch, H. H. Peter, H. H. Raspe, and W. L. Gross No difference in the incidences of vasculitides between north and south Germany: first results of the German vasculitis register Rheumatology, May 1, 2002; 41(5): 540 - 549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Schmidt, J. Schulte-Monting, and E. Reinhold-Keller Giant cell arteritis is more prevalent in urban than in rural populations Rheumatology, October 1, 2001; 40(10): 1193 - 1193. [Full Text] [PDF]
|
|