The UK prevalence of hereditary haemorrhagic telangiectasia and its association with sex, socioeconomic status and region of residence: a population-based study

Background Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disorder of aberrant blood vessel development characterised by arteriovenous malformations. HHT is associated with significant morbidity due to complications including epistaxis, gastrointestinal bleeding and stroke. We explored the hypothesis that a diagnosis of HHT is associated with sex, socioeconomic status and geographical location.Methods We used The Health Improvement Network, a longitudinal, computerised general practice database covering 5% of the UK population to calculate prevalence estimates for HHT stratified by age, sex, socioeconomic status and geographical location.Results The 2010 UK point prevalence for HHT was 1.06/10 000 person years (95% CI 0.95 to 1.17) or 1 in 9400 individuals. The diagnosed prevalence of HHT was significantly higher in women compared with men (adjusted prevalence rate ratio (PRR) 1.53, 95% CI 1.24 to 1.88) and in those from the most affluent socioeconomic group compared with the least (adjusted PRR 1.74, 95% CI 1.14 to 2.64). The PRR varied between different regions of the UK, being highest in the South West and lowest in the West Midlands (adjusted PRR for former compared with latter 1.86, 95% CI 1.61 to 2.15).Conclusions HHT prevalence is more common in the UK population than previously demonstrated, though this updated figure is still likely to be an underestimate. HHT appears to be significantly under-diagnosed in men, which is likely to reflect their lower rates of consultation with primary care services. There is under-diagnosis in patients from lower socioeconomic groups and a marked variation in the prevalence of diagnosis between different geographical regions across the UK that requires further investigation

Aquaculture over-optimism?

The recent rapid growth in aquaculture production reported by the United Nations Food and Agriculture Organization may have inadvertently generated what we denote here as aquaculture over-optimism. An extreme form of this is the notion that we need not worry about sustaining wild fish stocks because we can meet the global need through farming. Here we investigate whether the recent growth in aquaculture production can be maintained, and we compare aquaculture production projections with the future need for fish to find out whether aquaculture over-optimism can be justified. We show relevant evidence suggesting that aquaculture growth rates in all the cases studied have already reached their peak and have begun declining. Also, our results indicate that without wild fish, the world will face a fish food shortage of about 71 million tonnes annually by 2030, and the aquaculture production growth rate would have to be 3 times current average projected production by the FAO, the World Bank and the OECD in 2030. Finally, the current geographical distribution of farmed fish production suggests that even if aquaculture over-optimism is physically, economically, technically and ecologically feasible, its socio-economic cost to low-income coastal countries could be devastating