Perthes’ disease of the hip: socioeconomic inequalities and the urban environment

  title={Perthes’ disease of the hip: socioeconomic inequalities and the urban environment},
  author={Daniel C. Perry and Colin E. Bruce and Daniel Pope and Peter H. Dangerfield and Mary Jane Platt and Andrew James Hall},
  journal={Archives of Disease in Childhood},
  pages={1053 - 1057}
Introduction Perthes’ disease is a puzzling childhood hip disorder for which the aetiology is unknown. It is known to be associated with socioeconomic deprivation. Urban environments have also been implicated as a risk factor, however socioeconomic deprivation often occurs within urban environments and it is unclear if this association is the result of confounding. The objective of the current work was to gain a greater understanding of the influence of the urban/rural environment in Perthes… 

Incidence of Perthes’ disease in children born between 1973 and 1993

There is a association between the incidence of Perthes’ disease and the socioeconomic status of the parents, and this study confirms that there is an association between these factors and the incidence was lower when the fathers were in the highest income bracket.

Unravelling the enigma of Perthes disease.

  • D. Perry
  • Medicine
    Annals of the Royal College of Surgeons of England
  • 2013
Despite a falling incidence, Perthes disease remains an important cause of child morbidity and exemplifies socioeconomic inequalities and a deprivation-related exposure, acting early in development, appears critical.

A case control study to determine the association between Perthes' disease and the recalled use of tobacco during pregnancy, and biological markers of current tobacco smoke exposure

An association exists between tobacco smoke exposure and Perthes' disease but the authors remain unable to disentangle the association with socioeconomic deprivation.

The British Orthopaedic Surgery Surveillance study: Perthes’ disease

There appears to be a sufficient case volume and community equipoise among surgeons to embark on a randomized clinical trial to definitively investigate the effectiveness of containment surgery, and an optimized decision tree identified joint stiffness and age above eight years as the key determinants for containment surgery.

What are the Demographics and Epidemiology of Legg-Calvé-Perthes Disease in a Large Southern California Integrated Health System?

The authors' study of a large integrated healthcare system in Southern California revealed an increased association of male sex and young age (2 to 5 years old) with LCPD and the overall incidence was lower overall than previously reported, although the incidence seen in white patients was similar to that in prior studies.

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  • D. PerryA. Hall
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    The Orthopedic clinics of North America
  • 2011

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The literature available on the aetiology of LCPD presents major limitations in terms of great heterogeneity and a lack of high-profile studies, so more studies are needed to understand the complex and multifactorial genesis of the avascular necrosis characterizing the disease.

Clinical and genetic characteristics of Legg-Calve-Perthes disease

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Perthes Disease in a Child With Osteogenesis Imperfecta From a Rare Genetic Variant: A Case Report

There might be an association between OI and Perthes disease, and this case report enriches the phenotypes of osteogenesis imperfecta and provides insight into the pathogenesis of LCPD.

Legg-Calvé-Perthes disease and the risk of ADHD, depression, and mortality

Individuals with LCPD have a higher mortality risk, with higher risk of suicide and cardiovascular diseases, and hyperactivity could expose the femoral head to higher mechanical stress and contribute to the etiology of LCPD.



Perthes' disease: deprivation and decline

The magnitude of the association with deprivation, and the changing incidence, strongly suggest that environmental factor(s) are a major aetiological determinant in Perthes' disease.

Epidemiology of Perthes' disease.

The normal birthweight and absence of association with known prenatal influences suggest a determinant acting in early postnatal life, which points to major environmental influences in the etiology associated with poverty.

Deprivation, urbanisation and Perthes' disease in Northern Ireland.

While the incidence of Perthes' disease was found to be associated with indicators of the level of deprivation for areas, there was no evidence to suggest that there was an increased risk in urban areas; the highest rate was found in the most deprived rural category.

Racial and geographic factors in the incidence of Legg-Calvé-Perthes' disease: a systematic review.

Latitude was a strong predictor of disease, even after adjustment for race, and latitude demonstrates a strong association with incidence, which may offer new epidemiologic insights into the determinants of Perthes' disease.

Legg-Calvé-Perthes disease in the UK: geographic and temporal trends in incidence reflecting differences in degree of deprivation in childhood.

The declining incidence, along with the geographic variation, suggests that a major etiologic determinant in Legg-Calvé-Perthes disease is environmental and closely linked to childhood deprivation.

The incidence of Perthes' disease in Southwest Scotland.

A higher incidence of Perthes' disease was noted in areas with a lower population density compared with those with a higher density, and no correlation between population density and deprivation scores for individual electoral wards within the region.

The epidemiology and aetiology of Perthes' disease in Norway. A nationwide study of 425 patients.

The findings point toward a single cause, either genetic or environmental, acting prenatally in the aetiology of Perthes' disease, which was undertaken over a five-year period from January 1996.

Perthes' disease of the hip in Liverpool.

Analysis of all new cases that occurred in Liverpool and adjacent parts of Knowsley and Sefton during 1976-81 showed a steep gradient with social class, which supports the hypothesis that undernutrition is a causative factor in the disease.

The incidence and distribution of Legg–Calvé–Perthes' disease in Liverpool, 1982–95

It is suggested that environmental influences may come into play some years before a child presents with pain in the hip, and there may be a genetic predisposition to the disease.

Environmental Tobacco and Wood Smoke Increase the Risk of Legg-Calvé-Perthes Disease

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