Prevalence of hereditary hemochromatosis in 16031 primary care patients

Ann Intern Med. 1998 Dec 1;129(11):954-61. doi: 10.7326/0003-4819-129-11_part_2-199812011-00006.

Abstract

Background: Despite evidence from screening studies in northern European populations, the prevalence of hemochromatosis in primary care populations in the United States remains speculative.

Objective: To establish the feasibility of screening for hemochromatosis and to estimate the prevalence of hemochromatosis in a large primary care population.

Design: Cross-sectional prevalence study.

Setting: 22 primary care practices in the Rochester, New York, area.

Patients: 16031 ambulatory patients without a previous diagnosis of hemochromatosis.

Intervention: Serum transferrin saturation screening tests were offered to all adult patients in participating primary care practices.

Measurements: Patients with a serum transferrin saturation of 45% or more on initial testing had a serum transferrin saturation test done under fasting conditions and had serum ferritin levels measured. Those who had a fasting serum transferrin saturation of 55% or more and a serum ferritin level of 200 microg/L or more with no other apparent cause were presumed to have hemochromatosis and were offered liver biopsy to confirm the diagnosis.

Results: 25 patients had biopsy-proven hemochromatosis; 22 patients met the clinical criteria for hemochromatosis but declined liver biopsy and were classified as having clinically proven hemochromatosis; and 23 patients had a serum transferrin saturation of 55% or more with no identifiable cause, indicating probable hemochromatosis. The prevalence of clinically proven and biopsy-proven hemochromatosis combined was 4.5 per 1000 (95% CI, 3.3 to 5.8 per 1000) in the total sample and 5.4 per 1000 (CI, 4.0 to 7.1 per 1000) in white persons. The prevalence was higher in men than in women (ratio, 1.8:1).

Conclusions: Hemochromatosis is relatively common among white persons. Routine screening of white persons for hemochromatosis should be considered by primary care physicians.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Biopsy
  • Cross-Sectional Studies
  • Feasibility Studies
  • Female
  • Hemochromatosis / diagnosis
  • Hemochromatosis / epidemiology*
  • Hemochromatosis / genetics*
  • Humans
  • Liver / pathology
  • Male
  • Mass Screening* / methods
  • Middle Aged
  • New York / epidemiology
  • Prevalence
  • Transferrin / metabolism

Substances

  • Transferrin