Evaluating pancreatitis in primary care: a population-based cohort study

Abstract

Background: Pancreatitis is an important condition with significant mortality. Primary care may have an important role to play in its prevention, early diagnosis, and ongoing management.

Aim: To evaluate incidence, case fatality, and clinical features of acute and chronic pancreatitis in a large population.

Design and setting: Population-based cohort study using a primary care database in the UK from 1990 to 2013.

Method: Use of general practice records from 16 491 patients diagnosed with pancreatitis. Age-standardised incidence rates and case fatality were estimated. Clinical features, aetiology, and patterns of recurrence were evaluated.

Results: Incidence of pancreatitis increased from 14.8 in 100 000 (1990-1994) to 31.2 in 100 000 (2010-2013) in males, and from 14.5 to 28.3 in 100 000 in females (2010-2013). Overall case fatality after diagnosis was 4.3% (95% CI = 4.0% to 4.6%) at 90 days and 7.9% (95% CI = 7.5% to 8.4%) at 365 days. In 1990-1994, 10% of patients with acute pancreatitis were recorded as heavy drinkers, increasing to 12% in 2010-2012; for patients with chronic pancreatitis the proportions were 13%, rising to 21%. Among patients who died in the 90 days after diagnosis, 92% consulted with their general practice in the 2 months before first diagnosis.

Conclusion: The incidence of pancreatitis is increasing over time. Alcohol abuse may now account for at least one in eight cases of acute, and one in five cases of chronic pancreatitis. Consultations among those who subsequently died may have offered potential for earlier diagnosis and intervention.

Keywords: alcohol abuse; gallstones; incidence; mortality; pancreatitis; primary care.