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. 2016 Jan-Feb;30(1):76-84.
doi: 10.1111/jvim.13815. Epub 2015 Dec 18.

Naturally Occurring Adrenocortical Insufficiency--An Epidemiological Study Based on a Swedish-Insured Dog Population of 525,028 Dogs

J M Hanson  1 , K Tengvall  2 , B N Bonnett  3 , Å Hedhammar  1
Affiliations

Naturally Occurring Adrenocortical Insufficiency--An Epidemiological Study Based on a Swedish-Insured Dog Population of 525,028 Dogs

J M Hanson et al. J Vet Intern Med. 2016 Jan-Feb.

Abstract

Background: Naturally occurring adrenocortical insufficiency (NOAI) in dogs is considered an uncommon disease with good prognosis with hormonal replacement treatment. However, there are no epidemiological studies with estimates for the general dog population.

Objectives: To investigate the epidemiological characteristics of NOAI in a large population of insured dogs.

Animals: Data were derived from 525,028 client-owned dogs insured by a Swedish insurance company representing 2,364,652 dog-years at risk (DYAR) during the period between 1995-2006.

Methods: Retrospective cohort study. Incidence rates, prevalences, and relative risks for dogs with NOAI (AI with no previous claim for hypercortisolism), were calculated for the whole dog population, and for subgroups divided by breed and sex. Mortality rates were calculated and compared in dogs with NOAI and the remaining dogs overall.

Results: In total 534 dogs were identified with NOAI. The overall incidence was 2.3 cases per 10,000 DYAR. The relative risk of disease was significantly higher in the Portuguese Water Dog, Standard Poodle, Bearded Collie, Cairn Terrier, and Cocker Spaniel compared with other breeds combined. Female dogs overall were at higher risk of developing AI than male dogs (RR 1.85; 95% CI, 1.55-2.22; P < .001). The relative risk of death was 1.9 times higher in dogs with NOAI than in dogs overall.

Conclusion and clinical importance: The data supports the existence of breed-specific differences in incidence rates of NOAI in dogs.

Keywords: Addison's disease; Hypoadrenocorticism; Incidence.

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Figures

Figure 1
Figure 1
Incidence rate of adrenocortical insufficiency (AI), excluding cases with a previous claim for hypercortisolism, in a population of 525,028 insured dogs. Data from breeds with ≥5 cases of AI, and from breeds that had a reduced relative risk (RR) with P < .05 before Bonferroni correction. NSDTR, Nova Scotia Duck Tolling Retriever; CKCS, Cavalier King Charles Spaniel; WHWT, West Highland White Terrier; DYAR, dog years at risk; IR, incidence rate, cases per 10,000 DYAR; CI, confidence interval; RR, relative risk of AI within the breed in comparison with the other breeds combined. Asterisks represent level of significance after conservative correction (Bonferroni, n = 115) for multiple testing: *P < .05; **P < .01; ***P < .001.
Figure 2
Figure 2
Incidence rate of adrenocortical insufficiency (AI), excluding cases with a previous claim for hypercortisolism, in female dogs by breed. Relative risk (RR) represents the RR of AI in female dogs compared to male dogs within the same breed. Data is shown for breeds with ≥5 cases of AI. NSDTR, Nova Scotia Duck Tolling Retriever; CKCS, Cavalier King Charles Spaniel; WHWT, West Highland White Terrier; DYAR, dog years at risk; IR, incidence rate; CI, confidence interval; RR, relative risk. Asterisks represent level of significance after conservative correction (Bonferroni, n = 28) for multiple testing: *P < .05; **P < .01; ***P < .001.
Figure 3
Figure 3
Mortality rate of adrenocortical insufficiency (AI) by breed in a population of 528,028 insured dogs. Dogs with a previous claim for hypercortisolism were excluded. Data are shown for breeds with ≥5 cases of AI. NSDTR, Nova Scotia Duck Tolling Retriever; CKCS, Cavalier King Charles Spaniel; WHWT, West Highland White Terrier; IR, incidence rate; CI, confidence interval; RR, relative risk of death of AI dogs in comparison with overall within the breed. Asterisks represent level of significance after conservative correction (Bonferroni, n = 28) for multiple testing: *P < .05; **P < .01; ***P < .001.
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