Canine atopic dermatitis: validation of recorded diagnosis against practice records in 335 insured Swedish dogs

Morbidity of insured Swedish cats between 2011 and 2016: Comparing disease risk in domestic crosses and purebreds

BACKGROUND

Sources of population-based cat health information are scarce. The objective of this study was to determine disease frequency in cats using pet insurance data to inform health promotion efforts.

METHODS

A descriptive analysis of cats insured with Agria Pet Insurance in Sweden (2011-2016) was performed. Incidence rates of broad disease categories were calculated based on veterinary care events and an exact denominator consisting of cat-years-at-risk. Rate ratios were calculated, comparing domestic crosses to all purebreds and specific purebreds to all other purebreds combined.

RESULTS

The study included over 1.6 million cat-years-at-risk (78.5% were domestic crosses), 18 breeds and 24 disease categories. The most common disease categories causing morbidity in purebreds were digestive, whole body, injury, urinary lower, skin and female reproduction. Purebreds had the highest relative risk (compared to domestics crosses) in the female reproduction, heart, operation complication, respiratory lower and immunological disease categories.

LIMITATIONS

There are typical limitations of secondary data, but they do not negate the overall value of such a large dataset.

CONCLUSION

This study demonstrates how pet insurance data can be used to find breed-specific differences in the incidence of various disease categories in cats. This may be of importance for breeders, cat owners, veterinarians and researchers.

Demography and disorders of English Cocker Spaniels under primary veterinary care in the UK

BACKGROUND

The English Cocker Spaniel (ECS) is a common family dog in the UK. This study aimed to describe demography, morbidity, and mortality in ECS under primary veterinary care in the UK during 2016 using data from the VetCompass™ Programme. This study hypothesised that the prevalence of aggression is higher in male than female ECS, and higher in solid-coloured than bi-coloured ECS.

RESULTS

English Cocker Spaniels comprised 10,313/336,865 (3.06%) of dogs under primary veterinary care during 2016. The median age was 4.57 years (inter-quartile range (IQR) 2.25-8.01) and the median adult bodyweight was 15.05 kg (IQR 13.12-17.35). The annual proportional birth rate was relatively stable between 2.97-3.51% from 2005-2016. The most common specific diagnoses were periodontal disease (n = 486, prevalence 20.97%, 95% confidence interval (CI): 19.31-22.62), otitis externa (n = 234, 10.09%, 95% CI: 8.87-11.32), obesity (n = 229, 9.88%, 95% CI: 8.66-11.09), anal sac impaction (n = 187, 8.07%, 95% CI: 6.96-9.18), diarrhoea (n = 113, 4.87%, 95% CI: 4.00-5.75), and aggression (n = 93, 4.01%, 95% CI: 3.21-4.81). The prevalence of aggression was higher in males (4.95%) than in females (2.87%) (P = 0.015) and in solid-coloured (7.00%) than in bi-coloured dogs (3.66%) (P = 0.010). The median age at death was 11.44 years (IQR 9.46-13.47) and the most common grouped causes of death were neoplasia (n = 10, 9.26%, 95% CI: 3.79-14.73), mass-associated disorders (n = 9, 8.33%, 95% CI: 4.45-15.08), and collapse (n = 8, 7.41%, 95% CI: 3.80-13.94).

CONCLUSIONS

Periodontal disease, otitis externa, and obesity are identified as the most common health issues for ECS, and neoplasia and mass-associated disorders as the most common reasons for death. The prevalence of aggression was higher in males and solid-coloured dogs. The results can aid veterinarians in giving evidence-based health and breed choice information to dog owners and highlights the importance of thorough oral examination and body condition score evaluation during routine veterinary examination of ECS.

The epidemiology of stifle joint disease in an insured Swedish dog population

BACKGROUND

Stifle joint diseases (SJD) are common in dogs and include a variety of diagnoses. The objective of the study was to provide an overview of the epidemiology of SJD in insured dogs.

METHODS

An historical single cohort study of dogs insured in Agria Pet Insurance (2011-2016) in Sweden was performed. Incidence and relative risk (RR) of SJD was calculated for the whole dog population and for subgroups divided by breed, breed group and sex.

RESULTS

The study population included almost 600,000 insured dogs (>1.7 million dog-years). Ninety-three different stifle joint diagnoses were reported in 9624 dogs, and the most common were cruciate ligament rupture and patellar luxation. The incidence of SJD was 55.4 cases per 10,000 dog-years at risk. Bulldog and boerboel had the highest RR of SJD. The breeds that accounted for the highest proportion of all SJD claimed dogs were mixed breed and Labrador retriever. Female dogs had a slightly increased RR compared with male dogs (RR 1.06, p = 0.006). The incidence increased yearly during the observation period.

CONCLUSION

The study demonstrates breed-specific differences in incidence of SJD in dogs, which may be of importance for breeders, dog owners and veterinarians.

Serum IgE and IgG responses to dietary antigens in dogs with and without cutaneous adverse food reactions

BACKGROUND

It is suspected that many canine cutaneous adverse food reactions (CAFR) are true immunological hypersensitivities; however, few specific dietary allergens have been identified.

OBJECTIVE

To compare serum immunoglobulin (Ig)E and IgG reactivity to specific food antigens in privately owned dogs with and without CAFR.

ANIMALS

Eighteen adult dogs with nonseasonal pruritus recruited from a hospital population.

METHODS AND MATERIALS

Dogs were fed an extensively hydrolysed poultry-based diet exclusively for 12 weeks. Serum was collected at the beginning of the trial. Canine atopic dermatitis extent and severity index and pruritus Visual Analog Scale scoring were performed at the beginning and end of the trial. Immunoblotting was performed to identify IgE and/or IgG binding to specific proteins in beef, egg, milk, chicken, pork, soy and wheat extracts.

RESULTS

A CAFR (defined as an unequivocal relapse of pruritus after dietary challenge) was diagnosed in 10 dogs, with 60% relapsing when fed chicken-based diets. Binding of subjects' IgG to almost all proteins in all extracts was seen regardless of reported dietary history. Few proteins were exclusively or predominantly bound by IgE in CAFR dogs. Exceptions included a 42 kDa band (chicken), a 52 kDa band (beef), a 46 kDa band (beef and milk) and a poorly defined high molecular weight protein or proteins (beef and milk).

CONCLUSION

This study demonstrated three protein bands and a poorly defined band predominantly recognized by sera from dogs with CAFR relative to non-CAFR dog sera. Almost all proteins were bound by IgG in all dogs, suggesting prior exposure to unreported foods.

Environmental and phenotype-related risk factors for owner-reported allergic/atopic skin symptoms and for canine atopic dermatitis verified by veterinarian in a Finnish dog population

The aim of this cross-sectional study was to observe whether environmental factors and phenotypic traits are associated with owner-reported skin problems and with veterinary diagnosed canine atopic dermatitis (CAD). Data were collected using the validated online DOGRISK questionnaire. Out of the data that the questionnaire provides for analysis, focus was first turned towards addressing questions regarding 'Atopy/allergy (skin symptoms)' using a total of 8643 dogs: 1585 dogs with owner-reported allergic/atopic skin symptoms and 7058 dogs without. A subsequent analysis compared dogs with veterinary-verified CAD (n = 322) as a case group against the 7058 dogs without owner-reported skin symptoms. The association between 21 factors related to the environment, canine phenotypes and breed groups within both populations were analysed using univariable and multivariable logistic regression. The environmental factors that showed a significant inverse association with the risk of owner-reported allergic/atopic skin symptoms were as following: whether the dog was living in a detached house, whether there were other dogs in the household, and whether the dog was born in the current household. Having over 50% white colour in the coat and living in an extremely clean household were significantly associated with an increased risk of owner-reported allergic/atopic skin symptoms. The five breeds demonstrating the highest proportion of owner-reported allergic/atopic skin symptoms were West Highland white terrier, Boxer, English bulldog, Dalmatian and French bulldog. The Fédération Cynologique Internationale dog breed groups 3 (Terriers) and 6 (Scent hounds and related breeds) showed a significantly higher risk for owner-reported allergic/atopic skin symptoms than mixed breed dogs. In the second population, the inverse association was observed between the risk of CAD and the presence of other dogs in the household, and whether the dog had been born in the current household. The results indicate that some environmental factors and canine phenotypes are associated with CAD and owner-reported skin symptoms, but they still do not prove causality.

Critically appraised topic on adverse food reactions of companion animals (3): prevalence of cutaneous adverse food reactions in dogs and cats

BACKGROUND

The prevalence of cutaneous adverse food reactions (CAFRs) in dogs and cats is not precisely known. This imprecision is likely due to the various populations that had been studied. Our objectives were to systematically review the literature to determine the prevalence of CAFRs among dogs and cats with pruritus and skin diseases.

RESULTS

We searched two databases for pertinent references on August 18, 2016. Among 490 and 220 articles respectively found in the Web of Science (Science Citation Index Expanded) and CAB Abstract databases, we selected 22 and nine articles that reported data usable for CAFR prevalence determination in dogs and cats, respectively. The prevalence of CAFR in dogs and cats was found to vary depending upon the type of diagnoses made. Among dogs presented to their veterinarian for any diagnosis, the prevalence was 1 to 2% and among those with skin diseases, it ranged between 0 and 24%. The range of CAFR prevalence was similar in dogs with pruritus (9 to 40%), those with any type of allergic skin disease (8 to 62%) and in dogs diagnosed with atopic dermatitis (9 to 50%). In cats presented to a university hospital, the prevalence of CAFR was less than 1% (0.2%), while it was fairly homogeneous in cats with skin diseases (range: 3 to 6%), but higher in cats with pruritus (12 to 21%) than in cats with allergic skin disease (5 to 13%).

CONCLUSIONS

Among dogs and cats with pruritus and those suspected of allergic skin disease, the prevalence of CAFR is high enough to justify this syndrome to be ruled-out with a restriction (elimination)-provocation dietary trial. This must especially be considered in companion animals with nonseasonal pruritus or signs of allergic dermatitis.

Breed, gender and age pattern of diagnosis for veterinary care in insured dogs in Japan during fiscal year 2010

We calculated the annual prevalence of diseases of 18 diagnostic categories in the insured dog population in Japan, using data from 299,555 dogs insured between April 2010 and March 2011. The prevalence was highest for dermatological disorders (22.6% for females and 23.3% for males), followed by otic diseases (16.4% for females and 17.2% for males) and digestive system disorders (15.7% for females and 16.4% for males). The prevalence of cardiovascular, urinary, neoplasia and endocrine disorders, increased with age; infectious diseases and injuries showed a high prevalence at young ages, and the prevalence of musculoskeletal and respiratory disorders showed a bimodal peak at young and old ages. A large variation in prevalence was observed between breeds for dermatological, otic, digestive, ophthalmological and cardiovascular disorders.

Approaches to canine health surveillance

Effective canine health surveillance systems can be used to monitor disease in the general population, prioritise disorders for strategic control and focus clinical research, and to evaluate the success of these measures. The key attributes for optimal data collection systems that support canine disease surveillance are representativeness of the general population, validity of disorder data and sustainability. Limitations in these areas present as selection bias, misclassification bias and discontinuation of the system respectively. Canine health data sources are reviewed to identify their strengths and weaknesses for supporting effective canine health surveillance. Insurance data benefit from large and well-defined denominator populations but are limited by selection bias relating to the clinical events claimed and animals covered. Veterinary referral clinical data offer good reliability for diagnoses but are limited by referral bias for the disorders and animals included. Primary-care practice data have the advantage of excellent representation of the general dog population and recording at the point of care by veterinary professionals but may encounter misclassification problems and technical difficulties related to management and analysis of large datasets. Questionnaire surveys offer speed and low cost but may suffer from low response rates, poor data validation, recall bias and ill-defined denominator population information. Canine health scheme data benefit from well-characterised disorder and animal data but reflect selection bias during the voluntary submissions process. Formal UK passive surveillance systems are limited by chronic under-reporting and selection bias. It is concluded that active collection systems using secondary health data provide the optimal resource for canine health surveillance.

Disease patterns in 32,486 insured German shepherd dogs in Sweden: 1995-2006

The aims of this retrospective study were to describe the morbidity and mortality in German shepherd dogs (GSD) in Sweden, based on insurance data, and to test the hypothesis that GSDs are predisposed to immune-related diseases. Morbidity was defined as incidence rates and based on veterinary care events. Mortality was defined as mortality rates and based on life insurance data. The study included 445,336 dogs, 7.3 per cent GSDs, covered by both veterinary care and life insurance between 1995 and 2006 in the Swedish insurance company Agria (Agria Insurance Company, Stockholm, Sweden). For veterinary care events (morbidity) GSDs were most over-represented for immunological disease, with a relative risk (RR) of 2.7, compared with the risk in all other breeds combined. The most common disease category (morbidity) in GSDs was skin disorders with an incidence rate of 346.8 cases per 10,000 dog years at risk. The highest RR for cause of death in GSDs compared with all other breeds was for skin conditions (RR=7.8). Locomotor disorders were the most common cause of death in GSDs. The GSD is predisposed to immune-related disorders, such as allergies, circumanal fistulae and exocrine pancreatic atrophy, with significantly increased risk compared with all other breeds.

Data quality in the Norwegian dairy herd recording system: agreement between the national database and disease recording on farm

The majority of herds in Norway participate in the national dairy herd recording system. For disease events, this involves transferring information registered on farm, using individual cow health cards (CHC), to the central cattle database (CCD). Before using data from such a database, validation with an aim of describing data quality should be performed, but is rarely done. In this study, diagnostic events from CHC and CCD from 74 dairy herds were compared. Events in 2008 from female cattle with minimum age of 1 yr were included (n=1,738). Discrepancies between the 2 data sources and assessment of data quality were evaluated using agreement between events on CHC and in CCD, calculating completeness and correctness for the CCD, and using a multivariable regression model for agreement (1/0). The agreement evaluation described the concordance between the 2 data sources, whereas the calculations of completeness and correctness depended on a reference data source assumed to be more reliable. Completeness of the CCD was defined as the proportion of diagnostic events on the CHC that was recorded therein. Correctness was defined as the proportion of the CCD events that was also recorded on the CHC, and with the same date and diagnostic code. The agreement was up to 87.5%, the majority of disagreement being caused by unreported events on the CHC (between 10 and 12% of all events). Completeness of the CCD was regarded as high, between 0.87 and 0.88, and correctness excellent, between 0.97 and 0.98. The multivariable regression model found 4 factors that increased the odds for diagnostic events being in agreement between CHC and CCD. These were the events occurring during the 305-d lactation period; the herd size being 75 cows or less; the event occurring during the spring, summer, or winter rather than autumn; and lastly, the diagnostic code for the disease event being preprinted on the CHC, involving a simple check mark as opposed to writing a 3-digit code. The model found a high degree of clustering within herd. In conclusion, disease data in the Norwegian national database for dairy cows are valid to use for epidemiologic research, having in particular an excellent correctness, but it is of concern that at least 10% of data are missing. The proportion of unreported data should be taken into consideration whenever data from this database are used. Reasons for discrepancies found are important to be aware of in any work aiming to improve data transfer from farm to central databases.

Validation of computerized diagnostic information in a clinical database from a national equine clinic network

BACKGROUND

Computerized diagnostic information offers potential for epidemiological research; however data accuracy must be addressed. The principal aim of this study was to evaluate the completeness and correctness of diagnostic information in a computerized equine clinical database compared to corresponding hand written veterinary clinical records, used as gold standard, and to assess factors related to correctness. Further, the aim was to investigate completeness (epidemiologic sensitivity), correctness (positive predictive value), specificity and prevalence for diagnoses for four body systems and correctness for affected limb information for four joint diseases.

METHODS

A random sample of 450 visits over the year 2002 (nvisits=49,591) was taken from 18 nation wide clinics headed under one company. Computerized information for the visits selected and copies of the corresponding veterinary clinical records were retrieved. Completeness and correctness were determined using semi-subjective criteria. Logistic regression was used to examine factors associated with correctness for diagnosis.

RESULTS

Three hundred and ninety six visits had veterinary clinical notes that were retrievable. The overall completeness and correctness were 91% and 92%, respectively; both values considered high. Descriptive analyses showed significantly higher degree of correctness for first visits compared to follow up visits and for cases with a diagnostic code recorded in the veterinary records compared to those with no code noted. The correctness was similar regardless of usage category (leisure/sport horse, racing trotter and racing thoroughbred) or gender.For the four body systems selected (joints, skin and hooves, respiratory, skeletal) the completeness varied between 71% (respiration) and 91% (joints) and the correctness ranged from 87% (skin and hooves) to 96% (respiration), whereas the specificity was >95% for all systems. Logistic regression showed that correctness was associated with type of visit, whether an explicit diagnostic code was present in the veterinary clinical record, and body system. Correctness for information on affected limb was 95% and varied with joint.

CONCLUSION

Based on the overall high level of correctness and completeness the database was considered useful for research purposes. For the body systems investigated the highest level of completeness and correctness was seen for joints and respiration, respectively.

Insurance data for research in companion animals: benefits and limitations

The primary aim of this article is to review the use of animal health insurance data in the scientific literature, especially in regard to morbidity or mortality in companion animals and horses. Methods and results were compared among studies on similar health conditions from different nations and years. A further objective was to critically evaluate benefits and limitations of such databases, to suggest ways to maximize their utility and to discuss the future use of animal insurance data for research purposes. Examples of studies on morbidity, mortality and survival estimates in dogs and horses, as well as neoplasia in dogs, are discussed.We conclude that insurance data can and should be used for research purposes in companion animals and horses. Insurance data have been successfully used, e.g. to quantify certain features that may have been hitherto assumed, but unmeasured. Validation of insurance databases is necessary if they are to be used in research. This must include the description of the insured population and an evaluation of the extent to which it represents the source population. Data content and accuracy must be determined over time, including the accuracy/consistency of diagnostic information. Readers must be cautioned as to limitations of the databases and, as always, critically appraise findings and synthesize information with other research. Similar findings from different study designs provide stronger evidence than a sole report. Insurance data can highlight common, expensive and severe conditions that may not be evident from teaching hospital case loads but may be significant burdens on the health of a population.

Comparison between dairy cow disease incidence in data registered by farmers and in data from a disease-recording system based on veterinary reporting

Sweden has a national disease-recording system based on veterinary reporting. From this system, all cattle-disease records are transferred to the dairy industry cattle database (DDD) where they are used for several purposes including research and dairy-health statistics. Our objective was to evaluate the completeness of this data source by comparing it with disease data registered by dairy farmers. The proportion of veterinary-treated disease events was estimated, by diagnosis. Disease incidence in the DDD was compared, by diagnosis and age, with disease data registered by the farmers. Comparison was made, by diagnosis, for (i) all disease events and (ii) those reported as veterinary-treated. Disease events, defined as "observed deviations in health, from the normal" were recorded by the farmers during January, April, July and October 2004. For the diagnoses calving problems, peripartum disorders, puerperal paresis and retained placenta, incidence proportions (IP) with 95% confidence intervals (CIs) were estimated. For all other disease problems, incidence rates (IR) were used. In total, 177 farmers reported at least 1 month and 148 reported all 4 months. Fifty-four percent of all disease events in the farmers' data were reported as veterinary-treated. For several of the most common diagnoses, the IRs and IPs for all events were significantly higher in farmers' data than in the DDD. Examples are, in cows: clinical mastitis, cough, gastro-intestinal disorders and lameness in hoof and limb; and in young stock: cough and gastro-intestinal disorders. For veterinary-treated events only, significant differences with higher IR in the farmers' data were found in young stock for sporadic cough and sporadic gastro-intestinal disorders. The diagnosis "other disorders" had significantly more events in the DDD than in farmers' data, i.e. veterinarians tended to choose more unspecific diagnoses than the farmers. This result indicates that the true completeness is likely to be higher than our estimate. We conclude that for the time period studied there was differential under-reporting associated with the diagnosis, the age of the animal and whether the herd was served by a state-employed or private veterinarian.

A prospective study on canine atopic dermatitis and food-induced allergic dermatitis in Switzerland

Canine atopic dermatitis sensu stricto and food-induced allergic dermatitis are common canine skin conditions, which are often considered clinically undistinguishable. Several attempts have been made to describe populations of atopic dogs and determine breed predisposition but the results were often biased by the use of hospital populations as control group. The present study aims to describe a population of Swiss atopic and food-allergic dogs and to compare it with a data set representing more than 85% of all Swiss dogs. The study, which was carried out during 1 year in several practices and teaching hospital in Switzerland, describes a group of 259 allergic dogs, determines breed predisposition for atopic dermatitis and food-induced allergic dermatitis, compares the clinical signs and features of both conditions, and outlines the clinical picture of five frequently affected breeds.

Validation of computerized Swedish horse insurance data against veterinary clinical records

The aim was to evaluate the agreement between computerized insurance data in a large Swedish horse insurance database and the information in the corresponding clinical records (CR). A random sample of 400 veterinary care and 140 life claims was included. Information on name of the horse, breed and gender, year of birth, specific diagnosis and system diagnosis (e.g. joints, digestive and skeletal) was compared between sources. The concordance for demographic variables was categorized as agreement, disagreement or data missing. For diagnostic information, the categories were agreement, minor disagreement and major disagreement and for system information agreement or disagreement. There were missing values for demographic information in the CR, varying from 2% for name to 16% for breed. The overall agreement for demographic information was >94% (disregarding missing data), 92% for system and 84% for specific diagnosis. For veterinary care and life claims, the observed agreement for diagnosis was 85 and 83%, minor disagreement 6 and 5%, and major disagreement 9 and 12%, respectively. Using the CR data as gold standard, for the systems evaluated (joints, digestive, skeletal, skin and hooves), sensitivity varied between 62% (skin) and 89% (digestive) whereas the specificity was >96% for all systems. The positive predictive values ranged from 86% (skin) to 97% (digestive). Logistic regression analysis was used to examine factors associated with agreement for diagnosis. Analyses were performed separately for veterinary care and life claims. Factors examined were type of visit (clinic/field), treating veterinarian/clinic (categorized as district veterinarians, private practitioners, small clinics, medium clinics and, for the clinics with > or =20 claims, the specific clinics), computerized or manual CR, processing clerk, whether the CR was included in the paper file, if the claim was rejected or reimbursed, system diagnosis and if a immediate settlement (in analysis for veterinary care claims) or death certificate (in analysis for life claims) was included in the paper file. For veterinary care claims, in the logistic regression model type of visit was significantly associated with agreement, with clinic visits generating better agreement than field visits.

The spatial distribution of atopic dermatitis cases in a population of insured Swedish dogs

Canine atopic dermatitis (CAD) is manifested by pruritus and inflammation of the skin, and most affected dogs have specific IgE against environmental allergens. Our aim was to evaluate whether in Sweden the incidence of CAD varies spatially, and to investigate possible environmental causes of such variation in a longitudinal study of CAD incidence among insured Swedish dogs. The dataset consisted of >220,000 individuals which had been covered by an insurance plan between January 1, 1995 and December 31, 2002. Out of these, 1235 CAD cases were identified and matched to postal-code areas based upon the address of the owner. Environmental risk factors we considered included averages of long-term annual rainfall, and of January and July temperatures. Initial visualization of the incidence rate of CAD (cases/dog-years at risk) expressed as empirical Bayes smoothed spatial rates indicated geographic variation. Moran's I, adjusted for population at risk, revealed significant global clustering. Both the spatial scan statistic and a local indicator of spatial autocorrelation revealed a higher incidence of CAD in the major cities. In a Poisson-regression model (with a spatial covariance structure), the incidence of CAD increased with increasing human population density, increasing average annual rainfall, living in the southern half of Sweden, and having a veterinary dermatologist in the county.