Global prevalence estimates of diffuse idiopathic skeletal hyperostosis: a systematic review and meta-analysis

Diffuse idiopathic skeletal hyperostosis (DISH) is a whole-body disease characterized by ossification or calcification of joints and ligaments, which is present on all continents and in all ethnic groups. However, there is a lack of comprehensive information on the global prevalence and incidence of DISH.

To conduct a systematic review and meta-analysis to investigate the global prevalence of DISH.

Three electronic medical databases (Cochrane Database of Systematic Reviews, MEDLINE, and Embase) were used to conduct a systematic review of population-based and clinical-based studies reporting the prevalence of DISH from the time of commencement to February 2023. "Prevalence or epidemiology" and "diffuse idiopathic skeletal hyperostosis or DISH" were the search terms used. There were no language restrictions. Extract data based on features such as continent, gender, age, and race. Quality was assessed using the Critical Appraisal Tool for Prevalence Data Reporting Studies from the Joanna Briggs Institute, which synthesizes the available evidence using a random effects model.

Among the 33 studies, the overall estimated prevalence of DISH in the general population (n=36925) was 11.92% (95% CI, 8.68%-15.59%), and the overall prevalence of DISH in clinical patients (n=22969) was about 14.30% (95%CI, 10.10%-19.09%). In 17 population-based studies, the prevalence of DISH was 10.07% (95% CI, 6.76%-13.95%) in Asia, 11.16% (95% CI, 6.19%-17.36%) in Europe, 13.46% in North America (95%CI, 12.20%-14.77%) and 30.07% (95%CI, 25.90%-34.49%) in Oceania. The overall prevalence of DISH by sex was 6.49% (95%CI, 3.65%-10.07%) in women and 17.87% (95%CI, 13.27%-22.98%) in men. The prevalence rate of Asians was 10.07% (95%CI, 6.76%-13.95%), that of white people was 11.90% (95%CI, 7.62%-16.98%), and that of black people was 8.77% (95%CI, 6.39%-11.67%). In 16 clinic-based studies, the prevalence of DISH was 16.32% (95%CI, 10.10%-23.67%) in Asia, 13.20% (95%CI, 9.89%-16.92%) in Europe, and 13.13%(95%CI, 3.79%-26.93%) in North America and 3.93% in Africa. According to gender classification, the overall prevalence of DISH was 10.16% (95%CI, 6.59%-14.38%) in women and 18.73% (95%CI, 12.84%-25.44%) in men. The prevalence rate of Asians was 16.45% (95%CI, 7.45%-28.05%), that of white people was 14.95% (95%CI, 10.28%-20.31%), and that of black people was 5.71% (95%CI, 2.57%-9.98%).

This study identifies the global prevalence of DISH in terms of population distribution, space, and time. The overall prevalence of DISH was approximately 11.92% (95%CI, 8.68%-15.59%) in the general population and 14.30% (95% CI, 10.10%-19.09%) in clinical patients. The prevalence of DISH was higher in males, and those aged 50 and over.