{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:54:39Z","timestamp":1788447279882,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2012,4,26]],"date-time":"2012-04-26T00:00:00Z","timestamp":1335398400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis &amp; Rheumatism"],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Little is known about Legg\u2010Calv\u00e9\u2010Perthes disease, a common childhood precursor to osteoarthritis of the hip. This study was undertaken to analyze the incidence of Legg\u2010Calv\u00e9\u2010Perthes disease in the UK, with respect to geographic and temporal trends over a 19\u2010year period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The General Practice Research database was analyzed to identify incident cases between 1990 and 2008 in children ages 0\u201314 years. Incidence rates were calculated by year and by region (National Health Service Strategic Health Authority regions in England, and Scotland, Wales, and Northern Ireland), and the association with regional markers of deprivation examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over the 19\u2010year period there was a dramatic decline in Legg\u2010Calv\u00e9\u2010Perthes disease incidence, with annual rates among children 0\u201314 years old declining from 12.2 per 100,000 to 5.7 per 100,000 (<jats:italic>P<\/jats:italic> &lt; 0.001). There was also marked geographic variation, with incidence rates in Scotland more than twice those in London (10.39 [95% confidence interval 8.05\u201313.2] versus 4.6 [95% confidence interval 3.4\u20136.1] per 100,000 0\u201314\u2010year\u2010olds). A more rapid decline in incidence was apparent in the Northern regions compared to Southern regions. The quintile with the highest degree of deprivation had the highest disease incidence (rate ratio 1.49 [95% confidence interval 1.10\u20132.04]) and, with the exception of London, regional incidence showed a strong linear relationship with regional deprivation score (<jats:italic>P<\/jats:italic> &lt; 0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The incidence of Legg\u2010Calv\u00e9\u2010Perthes disease in the UK has a strong North\u2010South divide, with a greater disease incidence within the Northern regions of the UK. There was a marked decline in incidence over the study period, which was more marked in Northern areas. The declining incidence, along with the geographic variation, suggests that a major etiologic determinant in Legg\u2010Calv\u00e9\u2010Perthes disease is environmental and closely linked to childhood deprivation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.34316","type":"journal-article","created":{"date-parts":[[2011,12,5]],"date-time":"2011-12-05T18:36:31Z","timestamp":1323110191000},"page":"1673-1679","source":"Crossref","is-referenced-by-count":49,"title":["Legg\u2010Calv\u00e9\u2010Perthes disease in the UK: Geographic and temporal trends in incidence reflecting differences in degree of deprivation in childhood"],"prefix":"10.1002","volume":"64","author":[{"given":"Daniel C.","family":"Perry","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin E.","family":"Bruce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Pope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Dangerfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Jane","family":"Platt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Hall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,4,26]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.287.6407.1757"},{"key":"e_1_2_6_3_2","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1302\/0301-620X.71B2.2925740","article-title":"Perthes' disease in Yorkshire","volume":"71","author":"Hall AJ","year":"1989","journal-title":"J Bone Joint Surg Br"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.82B2 .10033"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.84.4.351"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B11.16744"},{"key":"e_1_2_6_7_2","first-page":"9","article-title":"Incidence of Legg\u2010Calve\u2010Perthes' disease in the Faroe Islands","volume":"22","author":"Niclasen S","year":"1974","journal-title":"Ann Soc Sci Faroensis"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.88B9.17400"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.60B4.711792"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/17.3.603"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-0307"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199313050-00008"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.90B11.20318"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.1989.tb00505.x"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.60B4.711791"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.70B4.3403608"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.302.6779.766"},{"key":"e_1_2_6_18_2","volume-title":"The English indices of deprivation 2007","author":"Noble M","year":"2008"},{"key":"e_1_2_6_19_2","volume-title":"Households below average income 2000\/01","author":"Department for Work and Pensions","year":"2002"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a113913"},{"key":"e_1_2_6_21_2","volume-title":"CHD prevalence modelling briefing document","author":"Walford H","year":"2008"},{"key":"e_1_2_6_22_2","volume-title":"Hypertension prevalence modelling briefing document","author":"Walford H","year":"2008"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.305.6868.1551"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.18356\/e5a0500a-en"},{"key":"e_1_2_6_25_2","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1302\/0301-620X.64B3.7096393","article-title":"The incidence of Perthes' disease in three population groups in the Eastern Cape region of South Africa","volume":"64","author":"Purry NA","year":"1982","journal-title":"J Bone Joint Surg Br"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(89)91722-4"},{"key":"e_1_2_6_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.300.6720.291"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d508"},{"key":"e_1_2_6_29_2","unstructured":"World Bank. 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