Dupuytren's disease, also known as Dupuytren's contracture, is a progressive fibromatosis disorder of the hand that predominantly affects the fingers. Characterized by the formation of collagen deposits in the palm, it can result in the fingers flexing in towards the palm in a way that cannot be fully straightened. While the exact cause of Dupuytren's disease is unknown, genetics and familial history are known risk factors. In this article, we analyze the global prevalence of this common yet debilitating condition.
North America
In North America, Dupuytren's disease is most prevalent in individuals of Northern European descent. Studies show that approximately 5-30% of white individuals in the United States and Canada have Dupuytren's disease in some form. The disorder is estimated to affect over 5 million Americans. Rates tend to be highest in individuals of Scandinavian, Scottish, Irish and Northern English ancestry. Native Americans and East Asians have much lower rates compared to whites.Among North Americans, prevalence increases with age. Most patients first experience symptoms in their 50s and 60s, though onset can occur earlier or later depending on family history and other risk factors. Men are nearly three times more likely to develop Dupuytren's than women. Occupations involving vibratory hand tools or repetitive manual labor also elevate risk.
Europe
Dupuytren's Disease is especially common among populations in Northern and Western Europe, likely due to historic genetic isolation. In these regions, prevalence may be as high as 30-40% in men over 60 years old. Scandinavia consistently reports some of the highest rates globally, at approximately 5-30% of adults affected. In Iceland, as many as 43% of males between 50-79 years old demonstrate Dupuytren's involvement based on ultrasound screening studies. Rates are lower but still significant in countries like Germany (15%), the Netherlands (10%), and the United Kingdom (8%). Prevalence tends to decrease moving south and east across Europe. The lowest observed rates are in populations around the Mediterranean. As with Northern America, males are more frequently impacted than females in European countries.
Australia and New Zealand
As former British colonies with large populations descended from Northern Europe, Australia and New Zealand also have elevated Dupuytren's disease occurrence compared to many other regions world-wide. Overall prevalence is estimated at around 5-10% in Caucasian males over 50 years old residing in these nations. Indigenous Aboriginal and Polynesian peoples have much lower incidence consistent with their ancestry. A large database study of over 6,000 Australian hospital records found Dupuytren's disease complications in 2.7% of general admissions, demonstrating it as a regularly encountered condition. Significant risk is seen in Australians of Anglo-Celtic heritage, especially those from rural areas engaged in manual labor industries. The disorder is encountered less in populations of Asian or Middle Eastern origins within Australia and New Zealand.
Asia
Rates of Dupuytren's contracture are generally quite low across most of Asia. Exceptions include island populations descended from European colonizers such as in Singapore (1.6% prevalence). Mainland Asian ethnicities like Chinese, Japanese, Korean and South Asian Indians typically experience Dupuytren's disease in less than 1% of cases. One review of 43 studies found an overall incidence in Asian populations of only 0.16%. The disease almost exclusively affects individuals with documented Western ancestry within Asian countries rather than native Asian ethnicities. Environmental and genetic differences are thought to underlie these marked regional variations. While still observed, Dupuytren's is considered rare among traditional Asian demographics. However, exposures like smoking, diabetes andmanual trades that increase risk are becoming more prevalent due to societal changes.
Africa
Africa demonstrates the overall lowest observed rates of Dupuytren's disease globally. Published reports of Dupuytren's contracture from African countries are extremely limited. One analysis of hand conditions in 511 Kenyan patients did not identify any cases. Known predisposing occupations and ancestry commonly seen elsewhere are generally not present in native sub-Saharan African communities. Isolated case reports exist of Dupuytren's affecting individuals with European familial backgrounds residing in South Africa. But among indigenous Bantu and other sub-Saharan ethnic groups, Dupuytren's contracture appears to be exceptionally rare based on medical literature from the region. Environmental and genetic protective factors in traditional African populations are thought to account for this pronounced difference compared to higher prevalence areas.
Conclusion
In summary, Dupuytren's disease demonstrates highly variable global distribution correlated to ancestry, living situation, and occupation. Northern European genetic heritage, rural manual labor, smoking, and conditions like diabetes confer elevated risk. Native populations in regions like Asia, Africa and Latin America experience remarkably lower rates than Northern America and Europe. Continued epidemiological studies can provide valuable insight into environmental influences vs genetic determinism underlying these prevalence gradients. With improved understanding, more targeted prevention strategies may one day reduce the burden of Dupuytren's disease worldwide.
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