Incidence of adult primary immune thrombocytopenia in England—An update

Abstract

Background Adult primary immune thrombocytopenia (ITP) is a rare bleeding disorder of unknown cause. Recent estimates of its incidence and trend over time were acquired for England. Method The primary ITP population (using ICD 10 code D693 and excluding secondary ITP cases; positive predictive value: 82.6%) was sourced from NHS Digital inpatient and outpatient. Incidence rate (IR) for England and by age groups, sex, and regions were calculated and trends were assessed using average annual percent change (AAPC). Results A total of 25 805 patients (mean age 59 years; females 57.8%) diagnosed between 2003 and 2014 was identified. IRs increased from 4.2/100 000 to 6.4/100 000 over this period (AAPC:4.3%). For all sex‐specific age groups, the IRs significantly increased over time, except 18–29 years males. The greatest increase was among females aged 30–39 (AAPC:8.7%). In contrast, among ≥70 years, ITP was more common in males (highest IR among ≥80 years males: 23.9/100 000). England's average annual IR was 6.1/100 000 for 2010–14. An estimated 2.5/100 000 (based on UKITP Registry data) was estimated to require 1st line treatment whereas 2.4/100 000 would have 1st and 2nd line treatments within 6 months from diagnosis. IRs for London and East Midlands were the highest (6.5/100 000). Conclusions This study found a rising incidence of primary ITP, with sharp increases among young women and elderly men. These findings put in context the impact of ITP on patients' lives and the healthcare services in England, especially with 17%–50% who may develop chronic ITP and require long‐term care.

Expert Report on Immune Thrombocytopenia: Current Diagnostics and Treatment – Recommendations from an Expert Group from Austria, Germany, and Switzerland

“…In recent years, there seems to be a trend toward a higher age at onset (∼60 years). Almost one-third of patients are more than 70 years old [4,5].…”

“…Differential diagnosis of thrombocytopenia in pregnancy. 1 EDTA, ethylenediaminetetra-acetic acid; 2 GT, gestational thrombocytopenia; 3 ITP, immune thrombocytopenia; 4 HIV, human immunodeficiency virus; 5 HELLP syndrome (hemolytic anemia, elevated liver enzymes, low platelets); 6 TTP, thrombotic thrombocytopenic purpura; 7 HIT, heparin-induced thrombocytopenia; 8 E.g., myelodysplastic syndrome, myeloproliferative neoplasms.…”

Older Adults and Immune Thrombocytopenia: Considerations for the Clinician

“…Several large epidemiological studies have shown that the ITP epidemiology is influenced by sex and age, 2 , 3 , 6 with peaks in young women and old men. ITP is also a geriatric disease, with incidence rates reaching 23.9/100 000 in men >80 years old in the United Kingdom 3 and 9/100 000 person-years in men >75 years old in France, 2 that is, an approximately 10-fold increase as compared with men aged 30 to 39 years in both studies. In a recent French study including 541 adults with incident ITP included in a prospective national registry, 251 (46%) were ≥65 years and among them, 47% were ≥80 years.…”

“… 1 Although it can affect individuals of all age categories, the disease incidence peaks in older patients. 2 , 3 Hence, combined with the worldwide trend in the ageing of the population, ITP is of particular interest for physicians taking care of older patients. ITP management is challenging in older versus younger patients given the frequent comorbidities and increased risk of bleeding, infections and thrombosis of the former group.…”

Expertenreport Immunthrombozytopenie – Aktuelle Diagnostik und Therapie

“…In den letzten Jahren scheint es einen Trend zu einem höheren Erkrankungsalter zu geben (um die 60 Jahre). Fast 1/3 der Patient*innen sind über 70 Jahre alt [4,5].…”