How common is Dupuytren disease?

The short answer is this:  much more common than you might think. Scroll to the bottom to get the summary numbers.

For the long answer, keep reading.

The details depend on where you get your data. One set of data comes from a large web-based survey (DiBenedetti 2010). One conclusion from this research is that Dupuytren disease is underreported. If the numbers are based on physician records, about 1% of the US population has Dupuytren disease, but based on this study’s patient survey, the actual number is over 7%. Physician charts mainly document the diagnoses the physician is treating. If the doctor isn’t treating a person’s Dupuytren disease, Dupuytren is not likely to be noted in the patient‘s chart. Another conclusion from this research is that Dupuytren disease is underdiagnosed. Less than one out of ten people are correctly diagnosed with Dupuytren disease by the first doctor they see for the problem.

Another set of data comes from a study combining data from many reports (Lanting 2014).

Their data, broken down by age and gender for those 35 and older, shows the percent of people diagnosed with Dupuytren disease increases steadily with age:

Chart 1. Percent of people with Dupuytren in western Europe.

Those are percentages. If we want to calculate the total number of people with Dupuytren disease, we have to know the number of people in each age and gender bracket. For this, let’s look at census data. Here are the number of people in each age/gender bracket based on the 2010 US Census data.

Chart 2. 2010 US Census data for people 35 and older.

Now, if we multiply the percent of people with Dupuytren by the number of people in each bracket we get the total number of people with Dupuytren in each bracket. The percent of people with Dupuytren disease in each age group goes up with age, but the number of people in each age group goes down with age. Combining these results in a bell-shaped curve of the total number of people with Dupuytren disease in each age group:

Chart 3. Number of US Dupuytren cases, combining data from Charts 1 and 2.

From this data, Dupuytren is 2.6 times twice as common in men as in women overall, but this ratio drops with age. In those under fifty, Dupuytren is ten times more common in men than in women. For people in their 60s, it’s just over twice as common in men. For those 85 and older, Dupuytren is more common in women.

Chart 4. Changes in Dupuytren gender ratio with age.

Population shifts also affect these projections. These have been projections of the total number of people with Dupuytren disease in the US in 2010. For comparison, This is the same projection based on US census data from the year 2000 (US Census data):

Chart 5. Comparison to projection based on Chart 2 and 2000 US Census Data.

Do all these people have bent fingers from Dupuytren contracture? No. Most people with Dupuytren disease don’t have contractures yet. The percent of all Dupuytren patients with contracture is between 8 and 33% (Degreef 2010, Lanting 2013, Diep 2015). Twenty percent is a commonly used figure. About 5% of Dupuytren patients have very aggressive disease (Hindocha 2006) which can’t be controlled well with any current treatment. A Dupuytren biomarker is needed to predict this on an individual basis. If 15 million Americans have Dupuytren disease, about 3 million have bent fingers. Three-quarters of a million have severe disease with a real chance of being permanently crippled.

Will all these people eventually develop bent fingers? No. Not everyone with Dupuytren nodules will progress to the point of needing treatment for bent fingers. The risk of progressing from a new nodule to the need for contracture treatment is estimated to be 20 to 40 percent per decade (Gudmundsson  2001, Reilly 2005, Millesi 2009). A Dupuytren biomarker is needed to predict this on an individual basis.

Conclusions

1. About 15 million Americans age 35 and older have Dupuytren disease. This accounts for 5% of the entire US population of 309 million. It accounts for 9.3% of the 163 million at-risk Americans aged 35 and older. For comparison with diabetes, 9.6% of Americans 20 years and older have physician-diagnosed diabetes. (CDC 2014).
2. 3 million in the US have bent fingers from Dupuytren disease.
3. 750,000 Americans have severe Dupuytren biology and the risk of being crippled despite available treatment.
4. After age 55, the percent of people with Dupuytren disease increases steadily in both men and women. By age 70, one-quarter of men have signs of Dupuytren, increasing to one-third by age 80.
5. The ratio of men to women with Dupuytren disease decreases steadily with age. Dupuytren is more common in women than men in those 85 and older.
6. Because of changing population demographics in the US:
   14. The total number of US Dupuytren cases increased from 14.2 million in 2000 to 16.2 million people in 2010.
   15. The percent of the US population 35 and older affected with Dupuytren disease increased from 8.7% in 2000 to 9.3% in 2010.
   16. The most common US age range shifted younger, from 70-74 years old in 2000 to 60-64 years old in 2010.

References

CDC 2014 https://www.cdc.gov/nchs/fastats/diabetes.htm

Diep 2015 Diep Gustave K, Agel Julie, Adams Julie E. (2015). “Prevalence of Palmar Fibromatosis with and without Contracture in Asymptomatic Patients.” Journal of Plastic Surgery and Hand Surgery 49 (4): 247–50.

Degreef 2010 Degreef Ilse, De Smet Luc. (2010). “A High Prevalence of Dupuytren’s Disease in Flanders.” Acta Orthopaedica Belgica 76 (3): 316–20.

Dibenedetti 2011 Dibenedetti DB, Nguyen D, Zografos L, Ziemiecki R, Zhou Xi. (2011). “Prevalence, Incidence, and Treatments of Dupuytren’s Disease in the United States: Results from a Population-Based Study.” Hand (New York, N.Y.) 6 (2): 149–58.

Gudmundsson  2001 Gudmundsson KG, Arngrimsson R, Jónsson T. Eighteen years follow-up study of the clinical manifestations and progression of Dupuytren’s disease. Scand J Rheumatol. 2001;30(1):31-4.

Hindocha 2006 Hindocha S, Stanley JK, Watson S, Bayat A. (2006). “Dupuytren’s Diathesis Revisited: Evaluation of Prognostic Indicators for Risk of Disease Recurrence.” Journal of Hand Surgery 31 (10): 1626–34.

Lanting 2013 Lanting Rosanne R, van den Heuvel Edwin R, Westerink Bram B, Werker Paul M, N. (2013). “Prevalence of Dupuytren Disease in The Netherlands.” Plast Reconstr Surg 132 (2): 394–403.

Lanting 2014 Lanting R, Broekstra DC, Werker PMN, van den Heuvel ER (2014). “A Systematic Review and Meta-Analysis on the Prevalence of Dupuytren Disease in the General Population of Western Countries.” Plastic and Reconstructive Surgery 133 (3): 593–603.

Millesi 2009 Millesi H (2009). Dupuytren’s Contracture. In G. Bentley (ed.), European Instructional Lectures. European Instructional Course Lectures 9, 137-152. Berlin, Heidelberg: Springer Berlin Heidelberg, 2009.

Reilly 2005 Reilly RM, Stern PJ, Goldfarb CA. A retrospective review of the management of Dupuytren’s nodules. J Hand Surg Am. 2005 30(5):1014-8.

US Census Data http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf

Wade 2016 Wade R, Igali L, Figus A. (2016). “Skin Involvement in Dupuytren’s Disease.” J Hand Surg Eur 2016,41(6):600-8.