title: Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review.
abstract: OBJECTIVE
  To systematically review trends in the epidemiology of the first attack of acute pancreatitis (AP) based on reported population-based studies.
  
  
  METHODS
  From Medline, we retrieved 18 full-length English language peer-reviewed original articles published from 1966 to June 2005 with population-based information on the epidemiology of first-attack AP. Trends over time were analyzed based on study- and country-specific data and the study site (UK vs non-UK).
  
  
  RESULTS
  Eight studies were from the UK and 10 from other European centers. An increase in the annual incidence per 100,000 for first-attack AP was reported in 10 of 12 studies with longitudinal data from 4 countries (UK, Sweden, Denmark, and Netherlands). The overall AP incidence seems to be higher in non-UK studies compared with that of UK, partly explained by a higher incidence of alcoholic pancreatitis in non-UK studies. A linear trend for increase in gallstone pancreatitis incidence over time was observed irrespective of the study site (UK or non-UK). The AP incidence and mortality increased with age. Gallstone pancreatitis was more common in female subjects, and alcoholic pancreatitis was more common in middle-aged male subjects. The AP case fatality (%) has decreased over time, but the overall population mortality rate per 100,000 has remained unchanged. Recurrence after the first attack is milder with a substantially lower mortality.
  
  
  CONCLUSIONS
  The incidence of AP seems to be increasing. Differences in the incidence and etiology between and within countries reflect differences in the risk factor prevalence. Case-fatality rate, but not the population-based mortality rate, decreased over time.
authors.affiliation: Division of Gastroenterology and Hepatology, John L. McClellan Memorial Veterans Hospital & University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. yadavd@dom.pitt.edu
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
authors.forename: Albert B
authors.initials: AB
authors.lastname: Lowenfels
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D000367:Age Factors; D004813:Epidemiology / Q000639:trends; D005060:Europe / Q000453:epidemiology; D005260:Female; D042882:Gallstones / Q000150:complications; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D010195:Pancreatitis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D019512:Pancreatitis, Alcoholic / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology