Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis

Abstract

Population incidence of Guillain-Barré syndrome (GBS) is required to assess changes in GBS epidemiology, but published estimates of GBS incidence vary greatly depending on case ascertainment, definitions, and sample size. We performed a meta-analysis of articles on GBS incidence by searching Medline (1966-2009), Embase (1988-2009), Cinahl (1981-2009) and CABI (1973-2009) as well as article bibliographies. We included studies from North America and Europe with at least 20 cases, and used population-based data, subject matter experts to confirm GBS diagnosis, and an accepted GBS case definition. With these data, we fitted a random-effects negative binomial regression model to estimate age-specific GBS incidence. Of 1,683 nonduplicate citations, 16 met the inclusion criteria, which produced 1,643 cases and 152.7 million person-years of follow-up. GBS incidence increased by 20% for every 10-year increase in age; the risk of GBS was higher for males than females. The regression equation for calculating the average GBS rate per 100,000 person-years as a function of age in years was exp[-12.0771 + 0.01813(age in years)] × 100,000. Our findings provide a robust estimate of background GBS incidence in Western countries. Our regression model may be used in comparable populations to estimate the background age-specific rate of GBS incidence for future studies.

Fig. 1

Study selection.

Fig. 2

a Plot of age-specific incidence rate of GBS per 100,000 person-years versus age in years, for 13 published studies. b Plot of age-specific incidence rate of GBS per 100,000 person-years versus age in years, for 6 published studies that provided rates in males. c Plot of age-specific incidence rate of GBS per 100,000 person-years versus age in years, for 6 published studies that provided rates in females.

Fig. 3

a Plot of average age-specific incidence rate of GBS per 100,000 person-years versus age in years based on regression analysis of 13 published studies, with pointwise 95% prediction intervals (dashed lines) and observed rates (bubbles proportional to the number of person-years). b Plot of average age-specific incidence rate of GBS per 100,000 person-years versus age in years based on regression analysis of 6 published studies that provided rates by sex (males: long dashed lines, females: short dashed lines).