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Buerger's disease in Nepal
1Tansen Mission Hospital, Nepal. fleshman@open.org
Insights
Thromboangiitis obliterans (Buerger's disease) amputations are 50 times more common in Nepal than North America. Extreme poverty, maize-heavy diets, and Himalayan residence are key co-factors alongside universal tobacco use.
Area of Science:
- Vascular Surgery
- Epidemiology
- Public Health
Background:
- Thromboangiitis obliterans (Buerger's disease) is a rare vascular condition.
- Previous incidence data is primarily from Western countries.
- High amputation rates suggest a significant, understudied regional burden.
Purpose of the Study:
- To determine the incidence of Buerger's disease amputations in Nepal.
- To investigate potential causative factors specific to the region.
- To compare findings with international data.
Main Methods:
- Retrospective analysis of 4-year discharge data from Tansen Mission Hospital.
- In-depth interviews with patients regarding lifestyle, diet, genetics, and geography.
- Calculation of incidence rates per 100,000 admissions.
Main Results:
- An incidence of 693/100,000 admissions was recorded.
- This represents an incidence approximately 50 times higher than in North America.
- Consistent co-factors identified: 100% tobacco use, extreme poverty, maize-based diet, and Himalayan foothills residence.
Conclusions:
- Nepal exhibits an exceptionally high incidence of Buerger's disease.
- Tobacco use is universal, but poverty, diet, and geography are critical contributing factors.
- Further research into these co-factors is crucial for targeted prevention strategies.
Abstract:
At Tansen Mission Hospital in the middle hill area of Nepal the 4-year discharge data base was surveyed for amputations due to thromboangiitis obliterans (Buerger's disease). An incidence of 693/100,000 admissions was found. This is 50 times higher than the North American incidence. We investigated causative factors by means of in-depth interviews about genetic background, life style, diet and geography. In addition to tobacco use which was 100%, we found only extreme poverty, a diet of mostly maize, and residence in the Himalayan foothills as consistent co-factors.