An assessment of the incidence of fistula-in-ano in four countries of the European Union

Background In spite of its long history, fistula-in-ano is generally considered to be relatively uncommon. Nevertheless, no comprehensive analysis of its incidence in developed countries is available. Our goal was to determine the actual incidence of fistula-in-ano based on the study of incidence in four countries of the European Union (EU). Materials and Methods We performed a search of hospital inpatient databases in five different countries. We obtained valid data from four European countries, namely, England (UK; Hospital Episodes Statistics), Germany (German hospitals' databases), Italy (Scheda di Dimissione Ospedaliera), and Spain (Conjunto Minimo Basico de Datos by Insalud-Spanish National Health Institute). Results The incidence of fistula-in-ano varied among the different populations in the EU. In the four countries examined, it ranged from 1.04 per 10,000/year in Spain to 2.32 per 10,000/year in Italy. A statistical comparison of rates from the different countries studied gives a confidence interval from 1.20 up to 2.80. The population that we studied represents almost 51% of the total population of the EU. Conclusions This study attempts to determine the actual incidence of fistula-in-ano in the European Community, which was previously uncertain despite its major negative effects on quality of life and the high cost of treatment. Our findings indicate that the incidence of fistula-in-ano in the four countries of the EU studied is significantly higher than that in the only previously published report of the incidence of fistula-in-ano in Europe. Nevertheless, our findings confirm the general perception that fistula-in-ano is a relatively uncommon disease.