title: Case-fatality from acute pancreatitis is decreasing but its population mortality shows little change.
abstract: OBJECTIVE
  The reasons for changing epidemiology of acute pancreatitis (AP) are poorly defined. We hypothesized that trends for severity, case-fatality and population mortality from AP will provide an insight into the rising burden of AP in the population. We evaluated trends in the hospitalizations, case-fatality, severity and population mortality related to AP in the US population.
  
  
  METHODS
  We used the National Hospital Discharge Survey to calculate age, sex and race standardized hospitalizations of and case-fatality rates for AP, and Vital Statistics to calculate AP-related population mortality from 1983 to 2010, using 2010 US census as the reference.
  
  
  RESULTS
  Number of discharges per 100,000 population with primary diagnosis of AP increased 2 times from 42.4 (95% CI 38.2-46.5) during 1983-1986 to 85.4 (95% CI 62.8-108.1) during 2007-2010. During corresponding intervals, case-fatality from AP decreased 62% from 2.02% (95% CI 2.01-2.04) to 0.79% (95% CI 0.78-0.80), but population mortality per million population due to AP as primary cause remained stable from 9.28 (95% CI 8.94-9.62) to 9.91 (95% CI 9.56-10.26), and from AP as any cause decreased significantly (but only 12%) from 20.87 (95% CI 20.36-21.38) to 18.48 (95% CI 18.00-18.96). Prevalence of severe AP increased from 5% (95% CI 4.95-5.05%) during 1991-1994 to 9.78% (95% CI 9.73-9.83%) during 2007-2010.
  
  
  CONCLUSIONS
  An increasing prevalence of severe disease suggests true population increase to be an important contributor to the rising incidence of AP. A lack of proportional increase in population mortality suggests the impact of medical advances in the evaluation and management of AP.
authors.affiliation: Saint Louis University Center for Outcomes Research (SLUCOR) and Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO, USA.
authors.forename: Satish
authors.initials: S
authors.lastname: Munigala
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: yadavd@upmc.edu.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D010195:Pancreatitis / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011153:Population; D015995:Prevalence; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Epidemiology; Incidence; Mortality; Pancreatitis; Severity; Trend