Does geographic location affect incidence of ANCA-associated renal vasculitis in northern Saskatchewan, Canada?

Anderson, Keltie; Klassen, J; Stewart, Samuel Alan; Taylor-Gjevre, Regina M.

doi:10.1093/rheumatology/ket226

Cited by 13 publications

(7 citation statements)

References 24 publications

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“…This predominance of MPA over GPA in renal involvement was also observed in Spain, Japan and Canada (Northern Saskatchewan), with latitudes 40 o N, 36 o N and 55 o N, respectively. 29 35 36 In comparison with European regions with similar latitudes to Scotland, our results are at variance. In the Netherlands (latitude 52 o N), GPA is twice as common as MPA in patients with AAV and renal involvement.…”

Section: Discussionmentioning

confidence: 69%

“…Therefore, results may not be representative for AAV. Looking at renal AAV, Anderson et al 29 observed higher incidences of renal AAV in rural Northern Saskatchewan, Canada (16.5 cases pmp/year in rural areas compared with 6.1 pmp/year in urban areas), but this was a small study of only 33 cases of renal AAV. Exposure to farming (OR 2.3 (95% CI 1.2 to 4.6)) has previously been considered as a contributory factor, and our data support exploring this further.…”

Section: Discussionmentioning

confidence: 84%

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ANCA-associated renal vasculitis is associated with rurality but not seasonality or deprivation in a complete national cohort study

et al. 2021

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BackgroundSmall studies suggest an association between ANCA-associated vasculitis (AAV) incidence and rurality, seasonality and socioeconomic deprivation. We examined the incidence of kidney biopsy-proven AAV and its relationship with these factors in the adult Scottish population.MethodsUsing the Scottish Renal Biopsy Registry, all adult native kidney biopsies performed between 2014 and 2018 with a diagnosis of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) were identified. The Scottish Government Urban Rural Classification was used for rurality analysis. Seasons were defined as autumn (September–November), winter (December–February), spring (March–May) and summer (June–August). Patients were separated into quintiles of socioeconomic deprivation using the validated Scottish Index of Multiple Deprivation and incidence standardised to age. Estimated glomerular filtration rate and urine protein:creatinine ratio at time of biopsy were used to assess disease severity.Results339 cases of renal AAV were identified, of which 62% had MPA and 38% had GPA diagnosis. AAV incidence was 15.1 per million population per year (pmp/year). Mean age was 66 years and 54% were female. Incidence of GPA (but not MPA) was positively associated with rurality (5.2, 8.4 and 9.1 pmp/year in ‘urban’, ‘accessible remote’ and ‘rural remote’ areas, respectively; p=0.04). The age-standardised incidence ratio was similar across all quintiles of deprivation (p=ns).ConclusionsSeasonality and disease severity did not vary across AAV study groups. In this complete national cohort study, we observed a positive association between kidney biopsy-proven GPA and rurality.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 84%

ANCA-associated renal vasculitis is associated with rurality but not seasonality or deprivation in a complete national cohort study

et al. 2021

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“…There are also studies investigating the influence of living in rural versus urban areas. The incidence of AAV was significantly higher in rural areas compared to urban areas in studies from Australia and Canada [71,96], while such a pattern was not seen for MPA and GPA in a Spanish study [76].…”

Section: Geographical Differencesmentioning

confidence: 79%

The Importance of Demographic and Geographical Factors on the Incidence and Outcome of Systemic Small Vessel Vasculitis Associated with Anti-Neutrophil Cytoplasmic Antibodies

Weiner

2019

Linköping University Medical Dissertations

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The anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) comprise microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA). Two serotypes are recognized: myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA. Renal involvement is a common and severe manifestation associated with increased mortality. The incidence varies geographically, but studies are difficult to compare due to heterogeneous methodology and inclusion criteria. AAV is commonly found in the elderly, but there are little data on outcome and optimal treatment in the highest age groups. This thesis focuses on the epidemiology of AAV: incidence, geographical distribution, and outcome. VDI Vasculitis Damage Index WBC white blood cell count WG Wegener's granulomatosis Table 1. ACR criteria for WG Criterion Definition Nasal or oral inflammation

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“…Studies in Scotland, Germany, and Canada showed that the incidence of AAV in rural areas is higher than that in cities. This may be related to environmental pollutants and pesticide exposure in remote areas (68,72,78,79). Additionally, a large Swedish case-control study (73) found no association between occupation and GPA (Table 1).…”

Section: Air Pollutionmentioning

confidence: 99%

Environmental factors influencing the risk of ANCA-associated vasculitis

et al. 2022

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Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of diseases characterized by inflammation and destruction of small and medium-sized blood vessels. Clinical disease phenotypes include microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA). The incidence of AAV has been on the rise in recent years with advances in ANCA testing. The etiology and pathogenesis of AAV are multifactorial and influenced by both genetic and environmental factors, as well as innate and adaptive immune system responses. Multiple case reports have shown that sustained exposure to silica in an occupational environment resulted in a significantly increased risk of ANCA positivity. A meta-analysis involving six case-control studies showed that silica exposure was positively associated with AAV incidence. Additionally, exposure to air pollutants, such as carbon monoxide (CO), is a risk factor for AAV. AAV has seasonal trends. Studies have shown that various environmental factors stimulate the body to activate neutrophils and expose their own antigens, resulting in the release of proteases and neutrophil extracellular traps, which damage vascular endothelial cells. Additionally, the activation of complement replacement pathways may exacerbate vascular inflammation. However, the role of environmental factors in the etiology of AAV remains unclear and has received little attention. In this review, we summarized the recent literature on the study of environmental factors, such as seasons, air pollution, latitude, silica, and microbial infection, in AAV with the aim of exploring the relationship between environmental factors and AAV and possible mechanisms of action to provide a scientific basis for the prevention and treatment of AAV.

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Does geographic location affect incidence of ANCA-associated renal vasculitis in northern Saskatchewan, Canada?

Abstract: The incidence of renal biopsy-proven AAV was higher in patients living in northern Saskatchewan smaller communities and rural settings. A significantly longer time to diagnosis existed for patients outside the urban centre and was associated with poorer BVAS, VDI and FFS scores.

Cited by 13 publications

References 24 publications

ANCA-associated renal vasculitis is associated with rurality but not seasonality or deprivation in a complete national cohort study

ANCA-associated renal vasculitis is associated with rurality but not seasonality or deprivation in a complete national cohort study

The Importance of Demographic and Geographical Factors on the Incidence and Outcome of Systemic Small Vessel Vasculitis Associated with Anti-Neutrophil Cytoplasmic Antibodies

Environmental factors influencing the risk of ANCA-associated vasculitis

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