In all age groups the male:female prevalence ratio decreased with

In all age groups the male:female prevalence ratio decreased with time. (B) The … There was a clear changing trend in the incidence of AS in women (figure 2). The most striking difference in incidence of AS between men and women was observed never between 2003 and 2006 (figure 2). The absolute male:female ratio in newly diagnosed patients with AS was 1.03 in 2010 compared with 1.30 in 1995 (χ2: 23.3; p<0.0001). To correct for the differences in the sex-stratified population at risk, the change in incidence rates in males and females was studied. There was an overall decrease in the difference between male and female incidence

rates over the years (figure 3B). The incidence of AS in males was not significantly different in 1995 and 2010 (χ2: 1.3; p=0.25) but the AS incidence rate in females was significantly higher in 2010 compared with 1995 (χ2: 33.39; p <0.0001). A greater proportion of male compared with female patients with AS entered the cohort at an earlier age (figure 3C). Among male patients with AS, 50.8% were diagnosed in the 15–45 age group compared with 44.2% of female patients with AS. The trend in male:female incidence rates over time show

more female patients than male patients with AS being diagnosed in the 45–65 age group from 2005 onwards (figure 3D). The male:female incidence ratios were stable overall in the 15–45 age group, but the ratio dropped in the >65 age group up to 2002 and then started to rise again. In the sex-specific AS incidence rates stratified by age group, the striking patterns that emerge include a drop in incident male patients with AS above 65 years of age in the initial period of follow-up and steady increase in incident female patients with AS in the 15–45 and 45–65 year age groups (see online supplementary figure S1). Discussion We report data from a large population-based study on incidence and prevalence of AS in North America. This is the largest epidemiological study on AS including close to 25 000 patients over a period of 15 years. Our

results suggest that AS prevalence trends remain steady and continue to affect a large number of people in North America. The incidence and prevalence of AS in women have increased at greater rates than for men, resulting in shifting gender ratios. Very few studies have reported incidence of AS from North America (table 2). The incidence reported by our study is the highest estimate AV-951 when compared with all other studies (table 2) and this is reflected in the high prevalence of AS in North America. In 1992, a population-based study from USA reported an annual incidence of 7.3/100 000 population.17 A systematic review published in 2014 reported continent-specific prevalence rates for AS with the highest prevalence in North America.10 The authors reported a prevalence of 31.9/10 000 population in North America.

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