The next speaker is Dr. Albert Isaacs, talking about the global incidence and prevalence of hydrocephalus. Thanks for the opportunity again. This is our attempt to try and get the epidemiology of hydrocephalus. We're all very intimately aware of hydrocephalus. We know that it's a multifactorial disease. There are several types of it, acrodactyl stenosis from pediatric population to the adult. But if you put a room of neurosurgeons and ask them what the incidence or prevalence of hydrocephalus is, usually you get answers ranging from five to 400 per 100,000, and nobody's really sure, but we reviewed some NIH grants, and it looks like the number is usually pegged at about 100 per 100,000 cases. So we had two main objectives to look at the prevalence and the incidence of hydrocephalus on a global perspective. And we realized very quickly that most of the papers that actually says incidence, that's actually not incidence. So we went back and did a major systematic review of all papers that have published on the prevalence of hydrocephalus. And then we took global birth defects surveillance groups, data from there to get access to incidence of hydrocephalus on a global level. So our systematic review on all major databases, and we set an a priori to only review papers after 1985 so we can capture papers that are published after the MRI era. And it was only population studies. And you know, as systematic reviews and meta-analysis go, garbage in, garbage out. So we set up a quality measure and only took papers that scored three out of eight on this validated quality assessment score. And to get incidence, we looked at 36 countries with 42 surveillance programs that report all sorts of birth defects, including hydrocephalus and spina bifida, associated hydrocephalus. After 2,460 papers, we drilled it down to 52 that had enough quality to be put in this particular paper. And it was all population-based hydrocephalus papers. Total population was over 170 million. Majority of the papers were coming from the pediatric population, very well done. The adult was very sparse, but you can also see that most of the population in the adult population were coming from the elderly population, usually from China and Europe. What we did find was that the prevalence of hydrocephalus in the pediatric population is 72 per 100,000 from reviewing all these papers. That is not including spina bifida associated hydrocephalus. And when you add that into the mix, you get about 88 per 100,000. The elderly population, which is over 65, was much higher, 174.77, but you can see the variation of the papers, and there is no standard on how to actually define hydrocephalus in that group. So the number could be either under or overrepresented. In the adult population, you barely find any papers between the age of 18 and 64 in the literature. It's only a few papers that we found, and it's also rarely 10.96 per 100,000. So for the incidence, we looked at these surveillance programs as I already talked about. And for every year, we get about 50, around 50 isolated hydrocephalus cases per 100,000 globally over the past five years as shown. And when you add the spina bifida associated hydrocephalus, the number goes up to, you get an incidence that's almost equal to a prevalence. We looked at separating these countries into high, low, and middle-income countries, and you can see that it's actually been very stable over the years. We're still trying to figure out what happened in 2013, but nothing is standing out at the moment. But it runs out that the low-income countries have higher prevalence, higher incidence of hydrocephalus. So we know it's a big problem. The annual incidence is alarming, especially in developing countries, and we should attempt to report these with discrete age groups. And the adult population doesn't have much data, so we need to address that transition care. Thank you very much. Thank you.

hydrocephalus

prevalence

incidence

epidemiology

global