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Nationwide Epidemiological and Demographic Evolution of Legg-Calvé-Perthes Disease: A 10-Year Analysis
Dev Laungani1, Olivia Ullmann1, Christopher J DeFrancesco1
1Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
The incidence of Legg-Calvé-Perthes disease (LCPD) in US children has declined, particularly in older age groups. However, the average age of diagnosis for LCPD has remained stable over the past decade.
Area of Science:
- Pediatric Orthopedics
- Epidemiology
- Public Health
Background:
- Legg-Calvé-Perthes disease (LCPD) affects children aged 2-14 years, with variable incidence rates reported.
- Nationally representative age data for LCPD in the US is limited.
- Previous studies suggested a potential trend towards younger ages at LCPD presentation.
Purpose of the Study:
- To investigate temporal trends in the epidemiology of LCPD.
- To analyze demographic characteristics of LCPD patients.
- To determine if the age of children presenting with LCPD has changed over time.
Main Methods:
- Retrospective review of LCPD cases in patients under 15 years old from 2015-2024.
- Data collected from a large tertiary care center and the TriNetX US Research network.
- Calculation of incidence rates (IR) per 100,000 children, stratified by age, sex, race, and ethnicity.
Main Results:
- A total of 3,495 LCPD cases were identified (average age: 7.4-7.7 years).
- Males constituted a significantly larger proportion of cases (78.3-82.9%).
- Overall LCPD incidence decreased significantly over time (nationwide IR ~6.75/100,000), with the most notable decline in children aged 10-14 years.
Conclusions:
- The incidence of LCPD in the US has decreased, with a contemporary nationwide rate around 7/100,000 children.
- The 5-9 year age group remains most affected, while declining incidence in older children contributes to the overall decrease.
- Average age at LCPD diagnosis has remained stable over the study period.
Background:
Legg-Calvé-Perthes disease (LCPD) classically affects children aged 2-14 years. However, there is considerable variability in reported incidence, and larger-scale nationally representative age data in the United States are lacking. Some investigators have also suggested that the age at presentation may be trending younger in recent years. Therefore, the purpose of this study was to explore temporal trends in the epidemiology and demographic characteristics of LCPD and determine whether the age of children presenting with LCPD is changing.
Methods:
A retrospective review of all patients under 15 years of age diagnosed with LCPD between January 1, 2015, and December 31, 2024, was conducted at a single large tertiary care center and using the TriNetX US Research network. Geographic and demographic information, including age, sex, race, and ethnicity, was collected. Incident cases were calculated per 100,000 children within the specified period.
Results:
A total of 3,495 children (330 regional and 3,162 nationwide) were diagnosed with LCPD in our 10-year period (average age: 7.7 ± 3.2 years [regional], 7.4 ± 3.4 years [nationwide]). Between both cohorts, males (78.3%, 82.9%) represented a significantly larger proportion than females (20.6%, 17.1%). The average incidence rate (IR) was 7.82 per 100,000 children at our center and 6.75 per 100,000 nationwide. Children aged 5-9 years represented the most common group of new diagnoses for all but 1 year across both cohorts. The overall disease incidence significantly decreased over time both regionally and nationally (P < .05). Nationally, disease incidence significantly decreased in children aged 10-14 years (P < .05) and appeared to trend downward regionally; the average age at diagnosis did not significantly decrease over time across both cohorts.
Conclusions:
In this large US study on the epidemiology of LCPD, we demonstrate both regional and nationwide IRs within a narrower range than previously described (∼7/100,000). The LCPD IR has significantly decreased over time, with the most prominent decrease seen in older children. We did not observe a significant change in the age of presentation over the last decade.
Key Concepts:
(1)The incidence of Legg-Calvé-Perthes disease (LCPD) in the United States has decreased over time, with a contemporary nationwide incidence rate of approximately 7 cases per 100,000 children.(2)Children aged 5-9 years remain the most commonly affected group, while new diagnoses among older children (10-14 years) have decreased and appear to be contributing to the overall declining disease incidence.(3)Despite these epidemiological shifts, average age at LCPD diagnosis has remained stable.
Level Of Evidence:
III, Retrospective cohort study.
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