Factors Contributing to the Incidence of Acute Pancreatitis
Factors Contributing to the Incidence of Acute Pancreatitis
During the 12-year study period, there were a total of 10 589 separate attacks of acute pancreatitis, among 8607 different patients. 7356 of the patients (85.5%) were admitted once only during the study period, 848 (9.9%) were admitted twice, 242 (2.8%) three times and 161 (1.9%) four times or more. The mean age of the patients was 57.7 years (s.d. = 19.2) and a slight majority (4362; 50.7%) were men. The overall incidence of acute pancreatitis, based on the 10 589 cases, was 30.0 per 100 000 population and the mortality rates at 30 days and 60 days were 5.6% and 6.4% respectively (based on 560 and 675 deaths).
Of the 10 589 cases, 3903 (36.9%) were of gallstone aetiology and 2327 (22.0%) were alcohol-induced. Other aetiologies or diagnoses recorded include hyperlipidaemia (1068; 10.1%), abdominal trauma (161; 1.5%), hypercalcaemia (61; 0.6%), malnutrition (27; 0.3%), pancreatic malignancies (21; 0.2%) and cystic fibrosis (12; 0.1%).
The incidence of acute pancreatitis overall was significantly higher (P < 0.001) among men (32.8 per 100 000) than women (27.8) and it increased across age groups (Table 1). The incidence of acute pancreatitis of gallstone aetiology increased sharply with age for both men and women (Figure 1a,b). It was significantly higher among women than men in younger age groups (<55 years) but more similar in men and women in older age groups. Alcoholic acute pancreatitis occurred most frequently among the 34–44 and 45–54 year age groups in both men and women, and was significantly higher among men than women in all age groups (Table 1).
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Figure 1.
Incidence of acute pancreatitis (per 100 000 population) for men and women in different age groups for gallstone and alcohol aetiologies, in Wales from 1999 to 2010. (a) Gallstone acute pancreatitis. (b) Alcoholic acute pancreatitis. Vertical bars represent 95% confidence intervals.
The incidence of acute pancreatitis increased from 27.6 per 100 000 population in 1999 to 35.9 per 100 000 in 2010 (Figure 2) with a significant (P < 0.001) mean annual increase of 2.7% per annum over the 12-year period (Table 1). There was little trend over time in mortality (mean annual reduction = 0.2%; Figure 2). Of all demographic age groups, incidence rose most sharply for women aged <35 years (7.9% increase per year), followed by men aged 35–44 years (5.7%) and men aged 45–54 years (5.3%; Table 1. Alcoholic acute pancreatitis rather than gallstone acute pancreatitis was the dominant aetiology in these three age-gender groups (43.2% vs. 27.4%; P < 0.001) while gallstone acute pancreatitis was more common in all other age-gender groups (40.5% vs. 13.8%; P < 0.001). The median length of stay was 6 days overall and fell over time from 7 days in 1999, 6 days during every year from 2000 to 2007 and 5 days in 2008, 2009 and 2010 (P < 0.001).
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Figure 2.
Trends in incidence (per 100 000 population) and mortality (at 60 days) following admission for acute pancreatitis, in Wales from 1999 to 2010. Incidence and mortality are standardised for age group and gender. Vertical bars represent 95% confidence intervals.
The incidence of acute pancreatitis was 1.9 times higher (95% CI = 1.8–2.0) among the most deprived quintile of patients compared with the most affluent quintile (Figure 3a). Figure 3b shows that this association between acute pancreatitis and social deprivation was much stronger for alcoholic aetiology (3.9; 95% CI = 3.4–4.5) than for gallstone aetiology (1.5; 1.4–1.7), or for all other and unspecified aetiologies (1.6; 95% CI = 1.4–1.7).
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Figure 3.
Incidence of acute pancreatitis (per 100 000 population) according to social deprivation quintile (I = most affluent, V = most deprived) in Wales from 1999 to 2010 for (a) All acute pancreatitis. (b) Gallstone and alcoholic acute pancreatitis. Incidence is standardised for age group and gender. Vertical bars represent 95% confidence intervals.
Across the 94 USOAs in Wales, there were positive correlations between the incidence of alcoholic acute pancreatitis and the average reported unit consumption of beer (0.46; P < 0.001), spirits (0.30; P = 0.004) and total alcohol (beer, spirits and wine; 0.35; P = 0.001) but there was a negative correlation between alcoholic acute pancreatitis and wine (−0.37; P < 0.001). Consumption of beer was correlated positively with spirits (0.22; P = 0.03) and negatively with wine (−0.58; P < 0.001) with no link between spirits and wine (0.02; P = 0.86). Social deprivation was correlated positively with consumption of beer (0.38; P < 0.001) and with total alcohol consumption (0.22; P = 0.033), negatively with wine (−0.35; P = 0.001) but was not correlated with spirits (0.03; P = 0.81).
The (hospitalised) incidence for acute pancreatitis was higher on weekdays (31.8 per 100 000; 95% CI = 31.1–32.5) than on weekends (25.6; 24.7–26.6) but similar with that on bank holidays (29.2; 25.5–33.3). Incidence varied according to the calendar month (P < 0.001 overall,P = 0.009 for gallstone acute pancreatitis and P = 0.024 for alcoholic acute pancreatitis). Incidence was highest during the months of August (32.8 per 100 000), October (32.0), December and July (both 31.8) and was significantly higher during each of these months [all (p < 0.05) than during February or March (Figure 4)].
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Figure 4.
Incidence of acute pancreatitis (per 100 000 population) according to the month of the admission, in Wales from 1999 to 2010, for (a) All acute pancreatitis. (b) Gallstone and alcoholic acute pancreatitis. Incidence is standardised for age group and gender. Vertical bars represent 95% confidence intervals.
Figure 5 shows smoothed daily trends in admissions for acute pancreatitis of alcohol and gallstone aetiologies during the months of December and January. Admissions for alcoholic pancreatitis during the last week of December and the first week of January were 48% higher (24–77%) than during the rest of the year and 64% higher (95% CI = 33–103%) than during the rest of December and January. For gallstone acute pancreatitis, however, there was no significant increase (9%) during the Christmas and New Year weeks compared with either the rest of the year or the rest of December and January (12%).
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Figure 5.
Trends in daily admission rates for gallstone and alcoholic acute pancreatitis (per 100 000 population) during the months of December and January, in Wales from 1999 to 2010.
Results
During the 12-year study period, there were a total of 10 589 separate attacks of acute pancreatitis, among 8607 different patients. 7356 of the patients (85.5%) were admitted once only during the study period, 848 (9.9%) were admitted twice, 242 (2.8%) three times and 161 (1.9%) four times or more. The mean age of the patients was 57.7 years (s.d. = 19.2) and a slight majority (4362; 50.7%) were men. The overall incidence of acute pancreatitis, based on the 10 589 cases, was 30.0 per 100 000 population and the mortality rates at 30 days and 60 days were 5.6% and 6.4% respectively (based on 560 and 675 deaths).
Of the 10 589 cases, 3903 (36.9%) were of gallstone aetiology and 2327 (22.0%) were alcohol-induced. Other aetiologies or diagnoses recorded include hyperlipidaemia (1068; 10.1%), abdominal trauma (161; 1.5%), hypercalcaemia (61; 0.6%), malnutrition (27; 0.3%), pancreatic malignancies (21; 0.2%) and cystic fibrosis (12; 0.1%).
The incidence of acute pancreatitis overall was significantly higher (P < 0.001) among men (32.8 per 100 000) than women (27.8) and it increased across age groups (Table 1). The incidence of acute pancreatitis of gallstone aetiology increased sharply with age for both men and women (Figure 1a,b). It was significantly higher among women than men in younger age groups (<55 years) but more similar in men and women in older age groups. Alcoholic acute pancreatitis occurred most frequently among the 34–44 and 45–54 year age groups in both men and women, and was significantly higher among men than women in all age groups (Table 1).
(Enlarge Image)
Figure 1.
Incidence of acute pancreatitis (per 100 000 population) for men and women in different age groups for gallstone and alcohol aetiologies, in Wales from 1999 to 2010. (a) Gallstone acute pancreatitis. (b) Alcoholic acute pancreatitis. Vertical bars represent 95% confidence intervals.
Trends in Acute Pancreatitis
The incidence of acute pancreatitis increased from 27.6 per 100 000 population in 1999 to 35.9 per 100 000 in 2010 (Figure 2) with a significant (P < 0.001) mean annual increase of 2.7% per annum over the 12-year period (Table 1). There was little trend over time in mortality (mean annual reduction = 0.2%; Figure 2). Of all demographic age groups, incidence rose most sharply for women aged <35 years (7.9% increase per year), followed by men aged 35–44 years (5.7%) and men aged 45–54 years (5.3%; Table 1. Alcoholic acute pancreatitis rather than gallstone acute pancreatitis was the dominant aetiology in these three age-gender groups (43.2% vs. 27.4%; P < 0.001) while gallstone acute pancreatitis was more common in all other age-gender groups (40.5% vs. 13.8%; P < 0.001). The median length of stay was 6 days overall and fell over time from 7 days in 1999, 6 days during every year from 2000 to 2007 and 5 days in 2008, 2009 and 2010 (P < 0.001).
(Enlarge Image)
Figure 2.
Trends in incidence (per 100 000 population) and mortality (at 60 days) following admission for acute pancreatitis, in Wales from 1999 to 2010. Incidence and mortality are standardised for age group and gender. Vertical bars represent 95% confidence intervals.
Acute Pancreatitis and Social Deprivation
The incidence of acute pancreatitis was 1.9 times higher (95% CI = 1.8–2.0) among the most deprived quintile of patients compared with the most affluent quintile (Figure 3a). Figure 3b shows that this association between acute pancreatitis and social deprivation was much stronger for alcoholic aetiology (3.9; 95% CI = 3.4–4.5) than for gallstone aetiology (1.5; 1.4–1.7), or for all other and unspecified aetiologies (1.6; 95% CI = 1.4–1.7).
(Enlarge Image)
Figure 3.
Incidence of acute pancreatitis (per 100 000 population) according to social deprivation quintile (I = most affluent, V = most deprived) in Wales from 1999 to 2010 for (a) All acute pancreatitis. (b) Gallstone and alcoholic acute pancreatitis. Incidence is standardised for age group and gender. Vertical bars represent 95% confidence intervals.
Acute Pancreatitis and Alcohol Consumption
Across the 94 USOAs in Wales, there were positive correlations between the incidence of alcoholic acute pancreatitis and the average reported unit consumption of beer (0.46; P < 0.001), spirits (0.30; P = 0.004) and total alcohol (beer, spirits and wine; 0.35; P = 0.001) but there was a negative correlation between alcoholic acute pancreatitis and wine (−0.37; P < 0.001). Consumption of beer was correlated positively with spirits (0.22; P = 0.03) and negatively with wine (−0.58; P < 0.001) with no link between spirits and wine (0.02; P = 0.86). Social deprivation was correlated positively with consumption of beer (0.38; P < 0.001) and with total alcohol consumption (0.22; P = 0.033), negatively with wine (−0.35; P = 0.001) but was not correlated with spirits (0.03; P = 0.81).
Acute Pancreatitis, Day of Week and Seasonal Effects
The (hospitalised) incidence for acute pancreatitis was higher on weekdays (31.8 per 100 000; 95% CI = 31.1–32.5) than on weekends (25.6; 24.7–26.6) but similar with that on bank holidays (29.2; 25.5–33.3). Incidence varied according to the calendar month (P < 0.001 overall,P = 0.009 for gallstone acute pancreatitis and P = 0.024 for alcoholic acute pancreatitis). Incidence was highest during the months of August (32.8 per 100 000), October (32.0), December and July (both 31.8) and was significantly higher during each of these months [all (p < 0.05) than during February or March (Figure 4)].
(Enlarge Image)
Figure 4.
Incidence of acute pancreatitis (per 100 000 population) according to the month of the admission, in Wales from 1999 to 2010, for (a) All acute pancreatitis. (b) Gallstone and alcoholic acute pancreatitis. Incidence is standardised for age group and gender. Vertical bars represent 95% confidence intervals.
Figure 5 shows smoothed daily trends in admissions for acute pancreatitis of alcohol and gallstone aetiologies during the months of December and January. Admissions for alcoholic pancreatitis during the last week of December and the first week of January were 48% higher (24–77%) than during the rest of the year and 64% higher (95% CI = 33–103%) than during the rest of December and January. For gallstone acute pancreatitis, however, there was no significant increase (9%) during the Christmas and New Year weeks compared with either the rest of the year or the rest of December and January (12%).
(Enlarge Image)
Figure 5.
Trends in daily admission rates for gallstone and alcoholic acute pancreatitis (per 100 000 population) during the months of December and January, in Wales from 1999 to 2010.
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