Population-based prevalence study of Behçet's disease: Differences by ethnic origin and low variation by age at immigration
Corresponding Author
Alfred Mahr
Université Paris 5–René Descartes, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
Department of Internal Medicine, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, 27 Rue du Faubourg St. Jacques, 75679 Paris Cedex 14, FranceSearch for more papers by this authorLinda Belarbi
Université Paris 5–René Descartes, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
Search for more papers by this authorBertrand Wechsler
Hôpital de la Pitié–Salpêtrière, Paris, France
Search for more papers by this authorDominique Jeanneret
Service Médical Assurance-Maladie Île-de-France (CNAMTS), Bobigny, France
Search for more papers by this authorJacky Ramanoelina
Hôpital Robert-Ballanger, Aulnay-sous-Bois, France
Search for more papers by this authorJoël Coste
Université Paris 5–René Descartes, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
Search for more papers by this authorLoïc Guillevin
Université Paris 5–René Descartes, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
Search for more papers by this authorCorresponding Author
Alfred Mahr
Université Paris 5–René Descartes, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
Department of Internal Medicine, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, 27 Rue du Faubourg St. Jacques, 75679 Paris Cedex 14, FranceSearch for more papers by this authorLinda Belarbi
Université Paris 5–René Descartes, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
Search for more papers by this authorBertrand Wechsler
Hôpital de la Pitié–Salpêtrière, Paris, France
Search for more papers by this authorDominique Jeanneret
Service Médical Assurance-Maladie Île-de-France (CNAMTS), Bobigny, France
Search for more papers by this authorJacky Ramanoelina
Hôpital Robert-Ballanger, Aulnay-sous-Bois, France
Search for more papers by this authorJoël Coste
Université Paris 5–René Descartes, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
Search for more papers by this authorLoïc Guillevin
Université Paris 5–René Descartes, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
Search for more papers by this authorAbstract
Objective
To estimate the prevalence of Behçet's disease (BD) in a multiethnic population living in France, with particular focus on disease risk among immigrants.
Methods
The study was conducted in a county in the Paris metropolitan area that is home to 1,094,412 adults (ages ≥15 years), of whom 26% are of non-European ancestry. Patients with BD living in this area during 2003 were identified using 3 sources (hospitals, community physicians, and the National Health Insurance database), and diagnoses were verified using the International Study Group criteria. Standardized, year-2003 prevalence rates were computed for the overall population and for each ethnic group. Stratified prevalence rates according to age at immigration to France were calculated to investigate the relationship between age at immigration and BD risk.
Results
Seventy-nine subjects fulfilled our search criteria. The overall prevalence per 100,000 adults was 7.1 (95% confidence interval [95% CI] 3.5–14.4), and the prevalence for populations of European, North African, and Asian ancestry was 2.4 (95% CI 0.6–7.2), 34.6 (95% CI 24.4–47.5), and 17.5 (95% CI 10.7–27.2), respectively. Within the migrant population of either North African or Asian ancestry, BD prevalences were similar for residents born in France, residents <15 years old at immigration, and residents ≥15 years old at immigration.
Conclusion
Our findings indicate that the prevalence of BD among immigrants of North African or Asian ancestry is significantly higher than that in the European-origin population, and comparable with rates reported from North Africa and Asia. Moreover, our results suggest that BD risk is not related to age at immigration. These findings support the hypothesis that BD has a primarily hereditary basis.
REFERENCES
- 1 Kaklamani VG, Vaiopoulos G, Kaklamanis PG. Behcet's disease. Semin Arthritis Rheum 1998; 27: 197–217.
- 2 Sakane T, Takeno M, Suzuki N, Inaba G. Behcet's disease. N Engl J Med 1999; 341: 1284–91.
- 3 Azizlerli G, Kose AA, Sarica R, Gul A, Tutkun IT, Kulac M, et al. Prevalence of Behcet's disease in Istanbul, Turkey. Int J Dermatol 2003; 42: 803–6.
- 4 Al-Rawi ZS, Neda AH. Prevalence of Behcet's disease among Iraqis. In: CC Zouboulis, editor. Adamantiaes-Behcet's disease. New York: Kluwer Academic/Plenum Publishers; 2003. p. 37–41.
- 5 Yamamoto S, Toyokawa H, Matsubara J, Yanai H, Inaba Y, Nakae K, et al. A nationwide survey on Behcet's disease in Japan. I. Epidemiological survey. Jpn J Ophthalmol 1974; 18: 282–90.
- 6 Kaneko F, Nakamura K, Sato M, Tojo M, Zheng X, Zhong-Zhang J. Epidemiology of Behcet's disease in Asian countries and Japan. In: CC Zouboulis, editor. Adamantiades-Behcet's disease. New York: Kluwer Academic/Plenum Publishers; 2003. p. 25–29.
- 7 Davatchi F. Epidemiology of Behcet's disease in Middle East and Asia. In: I Olivieri, C Salvarani, F Cantini, editors. 8th International Congress on Behcet's disease: program and abstracts; 1998 Oct 7–9; Reggio Emilia, Italy. Milan: Prex; 1998. p. 42.
- 8 Jaber L, Milo G, Halpern GJ, Krause I, Weinberger A. Prevalence of Behcet's disease in an Arab community in Israel. Ann Rheum Dis 2002; 61: 365–6.
- 9 Krause I, Yankevich A, Fraser A, Rosner I, Mader R, Zisman D, et al. Prevalence and clinical aspects of Behcet's disease in the north of Israel. Clin Rheumatol 2007; 26: 555–60.
- 10 Al-Dalaan A, Al Ballaa S, Al Sukati M, Mousa M, Bahabri S, Biyari T. The prevalence of Behcet's disease in Al Qassim region of Saudi Arabia. In: M Hamza, editor. Behcet's disease. Tunis (Tunisia): Pub Adhoua; 1997. p. 170–2.
- 11 Assaad-Khalil SH, Kamel FA, Ismail EA. Starting a regional registry for patients with Behcet's disease in North West Nile Delta region in Egypt. In: M Hamza, editor. Behcet's disease. Tunis (Tunisia): Pub Adhoua; 1997. p. 173–6.
- 12 Cakir N, Dervis E, Benian O, Pamuk ON, Sonmezates N, Rahimoglu R, et al. Prevalence of Behcet's disease in rural western Turkey: a preliminary report. Clin Exp Rheumatol 2004; 22 Suppl 34: S53–5.
- 13 Demirhindi O, Yazici H, Binyildiz P, Dayioglu N, Tuzun Y, Altac M, et al. The prevalence of Behcet's disease in Fener village (Silivri, Istanbul) and its surroundings. Cerrahpasa Tip Fak Derg 1981; 12: 509–14. In Turkish.
- 14 Idil A, Gurler A, Boyvat A, Caliskan D, Ozdemir O, Isik A, et al. The prevalence of Behcet's disease above the age of 10 years: the results of a pilot study conducted at the Park Primary Health Care Center in Ankara, Turkey. Ophthalmic Epidemiol 2002; 9: 325–31.
- 15
Davatchi F,
Jamshidi AR,
Banihashemi AT,
Gholami J,
Forouzanfar MH,
Moradi M, et al.
Prevalence of Behcet's disease in Iran: a WHO-ILAR COPCORD stage I study.
APLAR J Rheumatol
2007;
10:
239–243.
10.1111/j.1479-8077.2007.00295.x Google Scholar
- 16 Mousa AR, Marafie AA, Rifai KM, Dajani AI, Mukhtar MM. Behcet's disease in Kuwait, Arabia: a report of 29 cases and a review. Scand J Rheumatol 1986; 15: 310–32.
- 17 Nakae K, Masaki F, Hashimoto T, Inaba G, Mochizuki M, Sakane T. Recent epidemiological features of Behcet's disease in Japan. In: B Wechsler, P Godeau, editors. International Congress Series 1037. Amsterdam: Excerpta Medica; 1993. p. 145–51.
- 18 Yurdakul S, Gunaydin I, Tuzun Y, Tankurt N, Pazarli H, Ozyazgan Y, et al. The prevalence of Behcet's syndrome in a rural area in northern Turkey. J Rheumatol 1988; 15: 820–2.
- 19 Davatchi F, Shahram F, Akbarian M, Gharibdoost F, Nadji A, Chams C, et al. Behcet's disease—analysis of 3443 cases. APLAR J Rheumatol 1997; 1: 2–5.
- 20 Chamberlain MA. Behcet's syndrome in 32 patients in Yorkshire. Ann Rheum Dis 1977; 36: 491–99.
- 21 Papoutsis NG, Abdel-Naser MB, Altenburg A, Orawa H, Kotter I, Krause L, et al. Prevalence of Adamantiades-Behcet's disease in Germany and the municipality of Berlin: results of a nationwide survey [published erratum appears in Clin Exp Rheumatol 2007;25:507–8]. Clin Exp Rheumatol 2006; 24(5 Suppl 42 ): S125.
- 22 Chamberlain MA. Epidemiological features of Behcet's syndrome. In: F Lehner, CG Barnes, editors. Behcet's syndrome: clinical and immunologic features. Proceedings of a conference sponsored by the Royal Society of Medicine; 1979 February. London: Academic Press; 1979. p. 213–22.
- 23 Sanchez Burson J, Grandal Y, Mendoza M, Montero R, Rejon E, Marenco JL. Clinical characteristics, HLA antigen and mortality in Behcet's syndrome in Spain. In: I Olivieri, C Salvarani, F Cantini, editors. 8th International Congress on Behcet's disease: program and abstracts; 1998 Oct 7–9; Reggio Emilia, Italy. Milan: Prex; 1998. p. 102.
- 24 Salvarani C, Pipitone N, Catanoso MG, Cimino L, Tumiati B, Macchioni P, et al. Epidemiology and clinical course of Behcet's disease in the Reggio Emilia area of northern Italy: a seventeen-year population-based study. Arthritis Rheum 2007; 57: 171–8.
- 25 Crespo J, Ribeiro J, Jesus E, Moura A, Reis C, Porto A. Behcet's disease—particular features at the central zone of Portugal. In: B Wechsler, P Godeau, editors. International Congress Series 1037. Amsterdam: Excerpta Medica; 1993. p. 207–10.
- 26 Ek L, Hedfors E. Behcet's disease: a review and a report of 12 cases from Sweden. Acta Derm Venereol 1993; 73: 251–4.
- 27 Jankowski J, Crombie I, Jankowski R. Behcet's syndrome in Scotland. Postgrad Med J 1992; 68: 566–70.
- 28 Zouboulis CC, Kotter I, Djawari D, Kirch W, Kohl PK, Ochsendorf FR, et al. Epidemiological features of Adamantiades-Behcet's disease in Germany and in Europe. Yonsei Med J 1997; 38: 411–22.
- 29 O'Duffy JD. Summary of International Symposium on Behcet's Disease. Istanbul, September 29–30, 1977. J Rheumatol 1978; 5: 229–33.
- 30 Ohno S, Char DH, Kimura SJ, O'Connor GR. Clinical observations in Behcet's disease. Jpn J Ophthalmol 1979; 23: 126–31.
- 31 Hirohata T, Kuratsune M, Nomura A, Jimi S. Prevalence of Behcet's syndrome in Hawaii: with particular reference to the comparison of the Japanese in Hawaii and Japan. Hawaii Med J 1975; 34: 244–6.
- 32 Mahr A, Guillevin L, Poissonnet M, Ayme S. Prevalences of polyarteritis nodosa, microscopic polyangiitis, Wegener's granulomatosis, and Churg-Strauss syndrome in a French urban multiethnic population in 2000: a capture–recapture estimate. Arthritis Rheum 2004; 51: 92–9.
- 33 Le Guern V, Mahr A, Mouthon L, Jeanneret D, Carzon M, Guillevin L. Prevalence of systemic sclerosis in a French multi-ethnic county. Rheumatology (Oxford) 2004; 43: 1129–37.
- 34 URCAM (Unions Régionales des Caisses d'Assurance Maladie). Rapport d'activité 2006. Paris: UCARM; May 2007.
- 35 International Study Group for Behçet's Disease. Criteria for diagnosis of Behçet's disease [review]. Lancet 1990; 335: 1078–80.
- 36 Recensement de la population de 1999. Tableaux, references, et analyses – exploitation principale. Seine–Saint-Denis. Paris: Institut National des Statistiques et des Études Économiques; 2000.
- 37 Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJ, Lozano R, Inoue M. Age standardization of rates: a new WHO standard. GPE Discussion Paper Series: No. 31. Geneva: World Health Organization; 2000. URL: http://www.who.int/healthinfo/paper31.pdf.
- 38
Schoenberg BS.
Calculating confidence intervals for rates and ratios: simplified method utilizing tabular values based on the Poisson distribution.
Neuroepidemiology
1983;
2:
257–65.
10.1159/000110529 Google Scholar
- 39 Cormack R. The statistics of capture–recapture methods. Oceanography and Marine Biology Annual Review 1968; 6: 455–506.
- 40 Bishop YM, Fienberg SE, Holland PW. Discrete multivariate analysis: theory and practice. Cambridge (MA): MIT Press; 1975.
- 41 Gul A, Inanc M, Ocal L, Aral O, Konice M. Familial aggregation of Behcet's disease in Turkey. Ann Rheum Dis 2000; 59: 622–5.
- 42 Fresko I, Soy M, Hamuryudan V, Yurdakul S, Yavuz S, Tumer Z, et al. Genetic anticipation in Behcet's syndrome. Ann Rheum Dis 1998; 57: 45–8.
- 43 Molinari N, Kone Paut I, Manna R, Demaille J, Daures JP, Touitou I. Identification of an autosomal recessive mode of inheritance in paediatric Behcet's families by segregation analysis. Am J Med Genet A 2003; 122A: 115–8.
- 44 Verity DH, Marr JE, Ohno S, Wallace GR, Stanford MR. Behcet's disease, the Silk Road and HLA-B51: historical and geographical perspectives. Tissue Antigens 1999; 54: 213–20.
- 45 Gul A, Hajeer AH, Worthington J, Barrett JH, Ollier WE, Silman AJ. Evidence for linkage of the HLA-B locus in Behcet's disease, obtained using the transmission disequilibrium test. Arthritis Rheum 2001; 44: 239–40.
- 46 Gale CR, Martyn CN. Migrant studies in multiple sclerosis. Prog Neurobiol 1995; 47: 425–48.
- 47 Davatchi F, Shahram F, Akbarian M, Gharidboost F, Chams C, Chams H, et al. Classification tree for the diagnosis of Behcet's disease. In: B Wechsler, P Godeau, editors. International Congress Series 1037. Amsterdam: Excerpta Medica; 1993. p. 245–8.
- 48 Behcet's Disease Research Committee of Japan. Behcet's disease: guide to diagnosis of Behcet's disease. Jpn J Ophthalmol 1974; 18: 291–4.
- 49 Mizushima Y. Recent research into Behcet's disease in Japan. Int J Tissue React 1988; 10: 59–65.
- 50 O'Duffy JD. Suggested criteria for diagnosis of Behcet's disease [abstract]. J Rheumatol 1974; 1 Suppl 1: S18.
