Racial and Geographic Factors in the Incidence of Legg-Calvé-Perthes’ Disease: A Systematic Review

Abstract

Legg-Calvé-Perthes' disease (Perthes' disease) is a childhood osteonecrosis of the hip for which the disease determinants are poorly understood. In this review, the authors identify studies of Perthes' disease incidence published up to December 2010 and make denominator populations comparable in order to allow meaningful between-study evaluation. Incidence rates and confidence intervals were determined, and, where appropriate, denominator populations were obtained from national statistical offices. Poisson regression was used to determine the influence of race and geography. The review included 21 studies that described 27 populations in 16 countries, with 124 million person-years of observation. The annual incidence among children under age 15 years ranged from 0.2 per 100,000 to 19.1 per 100,000. Race was a key determinant, with East Asians being least affected and whites most affected, though data were insufficient to consider incidence among blacks (for South Asians vs. East Asians, incidence rate ratio = 2.9, 95% confidence interval (CI): 2.4, 3.5; for whites vs. East Asians, incidence rate ratio = 8.8, 95% CI: 8.2, 9.6). Latitude was a strong predictor of disease, even after adjustment for race. Each 10° increase in latitude was associated with an incidence increase of 1.44 (95% CI: 1.30, 1.58) times. While much of the international variation appears to be a function of race, latitude demonstrates a strong association. This observation may offer new epidemiologic insights into the determinants of Perthes' disease.

A case control study to determine the association between Perthes’ disease and the recalled use of tobacco during pregnancy, and biological markers of current tobacco smoke exposure

“…Internationally, children of white ancestry and residing at higher latitudes have an increased risk of disease 2 . There is strong evidence of a major association with socioeconomic deprivation 1,3-7 with disease incidence rates in the most deprived communities consistently greater than in the most affluent.…”

Legg-Calvé-Perthes hastalığının klinik ve radyolojik değerlendirilmesi ve direkt radyografi temelli sınıflama sistemleri

“…Erkek çocuklarda kızlara oranla dört kat daha sık görülmekte ve %10-15 oranında bilateral tutulum olmaktadır. [2] Femur başında kan akımında azalma ile kendini gösteren, çoğunlukla 2-12 yaş aralığındaki ço-cuklarda görülen bir rahatsızlıktır. Ağrı, femur başının çökmesi ve nihai olarak osteoartrit ile sonuçlanabile-cek bir klinik süreç izler.…”

A Twin Study of Perthes Disease

“…A number of studies have shown a strong association with socioeconomic deprivation in childhood. [2][3][4] Other proposed associations include small stature, 5 dietary deficiencies, 6 passive smoking, 7,8 childhood hyperactivity, 9 white European ancestry, latitude distance from the equator, 10 and an inherited predisposition to abnormal clotting. 11,12 In their early descriptions of LCPD, both Jacques Calvé 13 and Georg Perthes 14 described siblings with the disease.…”