Graft-versus-host disease epidemiology and demographics

Graft-versus-host disease
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Overview

There are no racial or geographic disparities regarding the prevalence of GvHD. GvHD carries a high morbidity rate across all subgroups of patients.

Epidemiology and Demographics

GvHD affects 30-70% of patients who undergo allogeneic transplant. It accounts for 15-30% of deaths after stem cell transplant. It is not an uncommon complication of stem cell transplant. It tends to occur more often in patients who have less genetic similarity compared to their donors. It typically occurs within the first 100 days of transplant (acute GvHD) (approximately 90-95% of cases), though it can also occur after the 100-day time point (chronic GvHD). It is thought to occur more commonly in men and in patients who receive donor stem cells from female multiparous donors, as there is a higher probability for HLA disparity in this group. There are no specific racial disparities in GvHD. It can occur in persons of any race.

The Center for International Blood and Marrow Transplant Research performed an analysis of data collected between 1999 and 2005 showing that the overall incidence of grades 2-4 GvHD was 39% in patients who received stem cells from sibling donors and 59% in patients who received stem cells from unrelated donors. It is important to note that the incidence of GvHD varies depending on the aggressiveness of diagnostic workup. If clinicians pursue diagnostic strategies like such as skin biopsy, liver biopsy, endoscopy, or colonoscopy even with minimal symptoms, a pathologic diagnosis may be present and a patient may be diagnosed with GvHD.

Overview

• The overview section should include the disease name in the first sentence.
• The goal is to summarize the page several sentences, and the section can be the same as the Epidemiology and demographics segment on the overview page.
• To see an example, click here.

Template

• First Sentence:

The prevalence of GvHD is estimated to be 5500 cases annually.

• Examples:

Example 1: In 2013, the incidence of shigellosis was estimated to be 5 to 10 cases per 100,000 individuals worldwide.

Example 2: The prevalence of craniopharyngioma is estimated to be 338 cases annually.

Example 3: Stomach cancer is the fifth most common cancer worldwide.

• Additional Sentences:

Additional Sentence 1: The case-mortality rate of [disease name] is approximately [number range] worldwide.

Additional Sentence 2: The majority of [disease name] cases are reported in [geographical region].

Additional Sentence 3: Patients of all age groups may develop GvHD, but it occurs more commonly in older persons who receive stem cells from female donors.

Additional Sentence 5: [Gender 1] are more commonly affected with [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.

Additional Sentence 6: [Disease name] affects men and women equally.

Additional Sentence 7: There is no racial predilection to [disease name].

Additional Sentence 8: [Disease name] usually affects individuals of the [ethnicity 1] race. [Ethnicity 2] individuals are less likely to develop [disease name].

Additional Sentence 9: The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.

Additional Sentence 10: [Chronic disease name] is usually first diagnosed among [age group].

Additional Sentence 11: [Acute disease name] commonly affects [age group].

Additional Sentence 12: [Disease name] commonly affects individuals younger than/older than [number of years] years of age.

• Examples:

Example 1: The case-mortality rate of MERS-CoV infection is approximately 30% to 50% worldwide.

Example 2: The majority of Chagas disease cases are reported in Central and South America.

Example 3: Patients of all age groups may develop hepatitis A infection.

Example 4: C. difficile infection is a common disease that tends to affect elderly patients > 65 years.

Example 5: Females are more commonly affected with Lupus than males. The female to male ratio is approximately 8 to 1.

Example 6: Brucellosis affects men and women equally.

Example 7: There is no racial predilection to leptospirosis.

Example 8: Melanoma usually affects individuals of the Caucasian race. African-American individuals are less likely to develop melanoma.

Example 9: The incidence of AML increases with age; the median age at diagnosis is 63 years.

Example 10: Lupus erythematosus is usually first diagnosed among young women.

Example 11: Mycoplasma pneumonia commonly affects young adults.

Example 12: Colon cancer commonly affects individuals older than 50 years of age.

Epidemiology and Demographics

Prevalence

• Worldwide, the prevalence of (insert disease state here) ranges from a low of _____ per 100,000 persons to a high of _____ per 100,000 persons with an average prevalence of _____ per 100,000 persons.
• Worldwide, the prevalence of (insert disease state here) is _____ per 100,000 persons.
• In developed countries, the prevalence of (insert disease state here) ranges from a low of _____ per 100,000 persons to a high of _____ per 100,000 persons with an average prevalence of _____ per 100,000 persons.
• In developed countries, the prevalence of GvHD is _____ per 100,000 persons.
• In developing countries, the prevalence of GvHD has not been studied, as bone marrow transplants are only performed in highly specialized centers.
• In ____ (insert year), the prevalence of _______ (insert disease name) was estimated to be _______ (insert number) cases per 100,000 individuals worldwide.

Incidence

• Incidence is defined as the number of new cases per population in a given time period.
• The standard format to report the incidence is ___ per 100,000 individuals.
• When using numbers with decimal points, avoid reporting more than 1 number after the decimal point. For example, report a incidence as 10.1 instead of 10.09322. Many numbers after the decimal point may suggest a false sense of accuracy.
• You can pick one or more of the template sentences below for this section:
  • Worldwide, the incidence of (insert disease state here) ranges from a low of _____ per 100,000 persons to a high of _____ per 100,000 persons with an average incidence of _____ per 100,000 persons.
  • Worldwide, the incidence of (insert disease state here) is _____ per 100,000 persons.
  • In developed countries, the incidence of (insert disease state here) ranges from a low of _____ per 100,000 persons to a high of _____ per 100,000 persons with an average incidence of _____ per 100,000 persons.
  • In developed countries, the incidence of (insert disease state here) is _____ per 100,000 persons.
  • In developing countries, the incidence of GvHD is not known since bone marrow transplants occur only in highly specialized centers.
  • In developing countries/ Africa, the incidence of (insert disease state here) is _____ per 100,000 persons.
  • In ____ (insert year), the incidence of _______ (insert disease name) was estimated to be _______ (insert number) cases per 100,000 individuals worldwide.

Case Fatality Rate

• The case fatality rate is defined the number of deaths (fatality) among patients with the disease (case). Case fatality rate should be distinguished from "Mortality Rate" (defined as the number of deaths among the at-risk population).
• The case fatality rate is usually described as a function of time (e.g. In 2015 / annually etc...).
• When using numbers with decimal points, avoid reporting more than 1 number after the decimal point. For example, report the case fatality rate as 10.1% instead of 10.09322%. Many numbers after the decimal point may suggest a false sense of accuracy.
• You can pick the template sentence below for this section:
  • In ____ (year), the case fatality rate of ____ (disease name) is ____ (case fatality rate in %).
  • The annual case fatality rate of ____ (disease name) is approximately ____ (case fatality rate in %).

Age

• This section can describe the impact of the disease depending on the persons age, and the age-specific prevalence and incidence.
• The prevalence of ____ (insert disease state here) increases/decreases with age.
• _____ (insert acute disease) commonly affects _____ (insert age group).
• _____ (insert chronic disease) is usually first diagnosed among _____ (insert age group).

Gender

This section describe how prevalence of the disease varies by gender. When describing male to female ratios with decimal points, avoid reporting more than 1 number after the decimal point. For example, report a ratio as as 1.5 to 1 instead of 1.48294 to 1. Many numbers after the decimal point may suggest a false sense of accuracy. You can use either of the following template sentences:

• ______ (insert gender 1) are more commonly affected with ______ (insert disease name) than _____ (insert gender 2). The _____ (insert gender ratio e.g. male to female) ratio is approximately _____ (insert number > 1) to 1.
• The prevalence and incidence of (insert disease state here) does not vary by gender.
• Men and women are affected equally by (insert disease name here).
• (Insert disease state here) is more prevalent in men women.
• The prevalence of (insert disease state here) among men is ____ per 100,000, while it is _____ per 100,000 among women.
• The incidence of (insert disease state here) among men is ____ per 100,000, while it is _____ per 100,000 among women.

Race

• The prevalence of GvHD does not vary by race.