The incidence of acute pancreatitis: impact of social deprivation, alcohol consumption, seasonal and demographic factors

Abstract

Background: The incidence of acute pancreatitis has increased sharply in many European countries and the USA in recent years.

Aim: To establish trends in incidence and mortality for acute pancreatitis in Wales, UK, and to assess how incidence may be linked to factors including social deprivation, seasonal effects and alcohol consumption.

Methods: Use of record linked inpatient, mortality and primary care data for 10,589 hospitalised cases of acute pancreatitis between 1999 and 2010.

Results: The incidence of acute pancreatitis was 30.0 per 100,000 population overall, mortality was 6.4% at 60 days. Incidence increased significantly from 27.6 per 100,000 in 1999 to 36.4 in 2010 (average annual increase = 2.7% per year), there was little trend in mortality (0.2% average annual reduction). The largest increases in incidence were among women aged <35 years (7.9% per year) and men aged 35-44 (5.7%) and 45-54 (5.3%). Incidence was 1.9 times higher among the most deprived quintile of patients compared with the most affluent (3.9 times higher for alcoholic acute pancreatitis and 1.5 for gallstone acute pancreatitis). Acute pancreatitis was increased significantly during the Christmas and New Year weeks by 48% (95% CI = 24-77%) for alcoholic aetiology, but not for gallstone aetiology (9%). Alcoholic admissions were increased with higher consumption of spirits and beer, but not wine.

Conclusions: The study shows an elevated rate of alcoholic acute pancreatitis during the Christmas and New Year period. Acute pancreatitis continues to rise, most rapidly for young women, while alcoholic acute pancreatitis is linked strongly with social deprivation.

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.

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.

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.

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

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.