BACKGROUND AND PURPOSE There has been an increasing prevalence of Moyamoya disorder (MMD) reported from recent US literature. There is a paucity of data available regarding trends of prevalence and epidemiological factors in the United States. To goal of this study was to test the hypotheses that racial-, sex-specific MMD hospitalizations and epidemiological factors have been increasing in the United States over the last decade. METHODS In this retrospective observational study, using the National Inpatient Sample (NIS) database from 2005 to 2016, MMD-related hospitalizations in patients aged ≥18 years were identified. Trends of epidemiological factors were analyzed over time using the linear regression model with the significance of differences in trend over time assessed using the Wald test. Sex- and race-specific burden of MMD were calculated using the annual US Census data. Joinpoint regression model was used to evaluate trends of hospitalizations over time. RESULTS A total of 24,484 adult hospitalizations were identified from January 2005 to September 2015 after excluding <18 years. Among them, approximately ~90% were aged ≤60 years, and 73.5% were females. The most common vascular and non-vascular presentations were ischemic stroke (17.3%) and seizures (21%), respectively. The trend of antithrombotic therapy has increased, while extracranial-intracranial bypass has remained stagnant. The actual average hospitalizations of MMD was 10.4 cases/ million population/year (range 4.1-17.9) and varied significantly by sex (females 14.7 [range 6.2-23.6] and males 5.9 [range 1.8-11.9]) over the 2005 to 2016 study period. The burden of hospitalizations also differed by race (African Americans 40.6 [range 32.8-63.7], Asians 24.8 [15.4-34.8], Non-Hispanic Whites 8.1 [range 6.4-11.5], and Hispanics 8.4 [2.8-12.8]) over the 2010 to 2016 study period. Joinpoint regression analysis showed an increasing overall MMD trend across the study period (+11.7%; P < 0.001), which was higher in males (+14.5% vs. +10.7%; P < 0.001). The Hispanic group had significantly increased hospitalizations over the years (+20.2%; P < 0.001). CONCLUSION Although overall more prevalent in females, MMD-related hospitalizations are increasing more rapidly in males. Among the racial subpopulations, African Americans had the highest MMD-related hospitalizations, even higher than Asian Americans. MMD-related hospitalizations have increased quicker in Hispanics than in any other racial group.

中文翻译：

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美国成人烟雾病住院趋势和流行病学特征

背景和目的 最近的美国文献报道了烟雾病 (MMD) 的患病率越来越高。关于美国流行趋势和流行病学因素的可用数据很少。本研究的目标是检验过去十年美国种族、性别特异性 MMD 住院率和流行病学因素一直在增加的假设。方法 在这项回顾性观察性研究中，使用 2005 年至 2016 年的国家住院样本 (NIS) 数据库，确定了 18 岁以上患者的 MMD 相关住院情况。使用线性回归模型随时间分析流行病学因素的趋势，并使用 Wald 检验评估随时间变化的趋势差异的显着性。使用年度美国人口普查数据计算 MMD 的性别和种族特定负担。Joinpoint 回归模型用于评估住院时间随时间的变化趋势。结果 从 2005 年 1 月到 2015 年 9 月，在排除 <18 岁之后，共确定了 24,484 名成人住院患者。其中，约 90% 为 60 岁以下，73.5% 为女性。最常见的血管性和非血管性表现分别是缺血性卒中 (17.3%) 和癫痫发作 (21%)。抗血栓治疗的趋势有所增加，而颅外-颅内搭桥术则停滞不前。在 2005 年至 2016 年的研究中，MMD 的实际平均住院人数为 10.4 例/百万人口/年（范围 4.1-17.9）并且因性别而异（女性 14.7 [范围 6.2-23.6] 和男性 5.9 [范围 1.8-11.9]）时期。住院负担也因种族而异（非裔美国人 40.6 [范围 32.8-63.7]，亚洲人 24.8 [15.4-34.8]，非西班牙裔白人 8.1 [范围 6.4-11.5]，西班牙裔 8.4 [2.8-12.8]） 2010年至2016年学习期。Joinpoint 回归分析显示整个研究期间 MMD 总体呈上升趋势（+11.7%；P < 0.001），男性更高（+14.5% 对 +10.7%；P < 0.001）。多年来，西班牙裔组的住院率显着增加（+20.2%；P < 0.001）。结论 尽管总体而言女性更普遍，但男性的 MMD 相关住院率增长更快。在种族亚群中，非裔美国人的 MMD 相关住院率最高，甚至高于亚裔美国人。西班牙裔美国人与 MMD 相关的住院人数增加得比任何其他种族群体都快。