Decreased Incidence of Acute Pancreatitis in Finland with Biliary Etiology Predominant in Initial Episodes: A Population-Based Study

BACKGROUND AND AIMS: In the 1990s, the incidence of acute pancreatitis (AP) in Finland exceeded 70 per 100,000 inhabitants, with alcohol as the etiology in 70% of cases, whereas in most other countries biliary etiology predominates. Diagnostic methods have since improved, and more recent studies have already reported lower incidence rates and a different etiologic distribution in Finland. We report a population-based study on the current incidence and etiology of AP in Pirkanmaa Finland. METHODS: All patients treated for AP at Tampere University Hospital during 2014-2015 were identified from hospital records. Patient demographics and etiology-related data were collected. RESULTS: The Pirkanmaa Hospital District population during the study period averaged 525,926. A total of 558 patients were treated for AP, comprising 622 episodes and yielding an incidence of 59.1 per 100,000 inhabitants. Of these, 451 patients (72.5%) presented with a first episode, corresponding to an incidence of 42.9 per 100,000. Among first episodes, etiology was biliary in 36.8% and alcoholic in 29.4%. For all episodes, biliary and alcoholic etiologies accounted for 32.5% and 34.1%, respectively. Other causes included post-ERCP (2.7%), tumor (3.2%), drug-induced (2.4%), autoimmune (1.4%), post-operative (1.0%), hypertriglyceridemia (0.6%), hypercalcemia (0.2%), SPINK1-associated (0.8%), miscellaneous (0.3%), idiopathic (10.6%), and not reliably determined (10.1%). CONCLUSION: The total incidence of AP in Pirkanmaa, Finland, was 59.1 per 100,000, and first-episode AP 42.9 per 100,000 - lower than historically reported and comparable to other Western countries. Biliary etiology was most common in first episodes, indicating that alcohol is no longer the predominant etiology of AP in the study area in Finland.