Targeting under-diagnosis in hereditary hemorrhagic telangiectasia: a model approach for rare diseases?

Orphanet Journal of Rare Diseases

Marie E Faughnan¹  Jonathan T Weyman⁴  Richard H Glazier²  Dale Brown⁵  Giuseppe A Latino³ 

[1] Toronto HHT Program, University of Toronto, Toronto, Canada;Institute for Clinical Evaluative Sciences, Toronto, Canada;Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Ontario, Canada;Department of Family and Community Medicine, St. Michael’s Hospital and University of Toronto, Toronto, Canada;Department of Otolaryngology/Head & Neck Surgery, Princess Margaret Hospital, University Health Network, Toronto, Canada

关键词: Epistaxis;    Rare disease;    Nose and throat (ENT);    Ears;    Prevalence;    Under-diagnosis;    Osler-Weber-Rendu;    Hereditary hemorrhagic telangiectasia (HHT);   

Others  :  1150183
DOI  :  10.1186/s13023-014-0115-7

 received in 2014-05-05, accepted in 2014-07-07,  发布年份 2014

【 摘 要 】

Background

Hereditary hemorrhagic telangiectasia (HHT), a rare autosomal dominant disease, is considered under-diagnosed. Our primary objective was to provide evidence of under-diagnosis of HHT in a North American population. We hypothesized that variation would exist in the diagnosed prevalence (D-prevalence) across regions in the province of Ontario, Canada and across age groups, due to under-diagnosis in certain groups. Our secondary objective was to collect data regarding contact and local access to consult specialists by HHT patients to help guide potential future diagnostic programs.

Methods

Primary objective- 556 adult patients with a definite HHT diagnosis seen at the Toronto HHT Centre were identified and geocoded with postal codes. Prevalence rates were calculated using Canadian census data. Secondary objective- A driving network model was developed in ArcGIS. Service area buffers around ear, nose and throat (ENT) clinics in Ontario were generated to evaluate the proportion of the Ontario population with access to these clinics. A survey was also sent to the email contact list of HHT Foundation International, targeting people with diagnosed HHT, regarding consultation with ENT physicians for epistaxis and timing of HHT diagnosis.

Results

Primary objective- D-prevalence rates varied among regions, from no cases to 1.1 cases per 5000 in large Ontario cities. There were no significant differences between urban and rural prevalence rates. Variation in prevalence was seen across age groups, with greater prevalence in older adults (≥50 years-old) compared with adults 20–49 years-old (0.36 versus 0.26 per 5000, p < 0.0005). Secondary objective- Most Ontarians had access to ENT clinics within a 30, 60 and 90 minute modeled drive time (92.7%, 97.8% and 98.6%, respectively). Nearly 40% of surveyed patients consulted an ENT physician for their epistaxis, on average 13.9 ± 12.2 years prior to being diagnosed with HHT.

Conclusions

The prevalence of HHT in Ontario is highly variable across regions and age-groups, suggesting under-diagnosis. Given that patients with HHT frequently consult ENT physicians for epistaxis prior to HHT diagnosis, and that there is almost universal access to ENTs in Ontario, we propose targeting ENT clinics as a province-wide approach to detect undiagnosed HHT patients and families.

【 授权许可】

   
2014 Latino et al. ; licensee Biomedcentral Ltd

【 图 表 】

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