Dupuytren’s Disease in the Hispanic
Population: A 10-Year Retrospective Review
Andrew L. Weinstein, B.S.
Nicholas T. Haddock, M.D.
Sheel Sharma, M.D.
New York, N.Y.
Background: Dupuytren’s disease is a common benign fibroproliferative dis-
order of the hand. Epidemiologic studies have reported significant variation in
disease prevalence among races, focusing primarily on those of northern Eu-
received little attention. Thus, in this study, the authors aimed to determine the
prevalence and operative rate of Dupuytren’s disease in the Hispanic, black,
white, Asian, Native American, and other races and to characterize the disease
presentation in Hispanics who required surgical treatment.
Methods: A retrospective review was conducted to identify the racial distribu-
tion of Dupuytren’s disease patients seen at Bellevue Hospital between July of
2000 and August of 2010. In Hispanic patients requiring surgical treatment for
their disease, data were collected on the following parameters: age, sex, eth-
nicity, hand dominance, hand affected, and digits operated on. Epidemiologic
epilepsy, and hypertension were also evaluated.
Results: Dupuytren’s disease prevalence was found to be 533 per 100,000 in
Hispanics. Of these patients, 1.8 percent required surgical treatment, and this
group was characterized by the following comorbidities: smoking (57.1 per-
(47.6 percent), and hypercholesterolemia (19.0 percent).
Conclusions: The authors’ results indicate that Dupuytren’s disease is more prev-
alent in the Hispanic population than previously reported. Although the epide-
in other races investigated, there are important differences with respect to clinical
presentation and surgical treatment.(Plast. Reconstr. Surg. 128: 1251, 2011.)
Although its etiopathology remains incompletely
understood, Dupuytren’s disease is thought to be
precipitated by a proliferation of contractile fibro-
blasts and myofibroblasts within the palmar fascia.1
This fibroblastic response initially presents as a nod-
that can cause a flexion contracture of any digit,
often along with skin pitting, tenderness, and
dimpling.2In its advanced stages, Dupuytren’s dis-
upuytren’s disease is a common benign fi-
broproliferative disorder that can be psycho-
socially and physically disabling to patients.
ease leads to a progressive and irreversible contrac-
ture of the palmar fascia and the involved digits.3
Both population studies and family studies
support an autosomal dominant inheritance pat-
tern of Dupuytren’s disease with incomplete
penetrance.4Overall, the prevalence ranges from
0.2 to 56 percent, varying greatly between geo-
graphic areas and races, with the highest rate re-
corded in a group of epileptic patients as a result
of prolonged administration of anticonvulsants.5
Moreover, gender studies on Dupuytren’s disease
3:1 to 9.5:1.6–10Although the disease has been
identified in persons of all racial groups,11,12the
highest prevalence reported in ethnicity studies is
in those of northern European descent (i.e., from
Langone Medical Center.
Received for publication February 20, 2011; accepted May
Presented at the 66th Annual Meeting of the American
Society for Surgery of the Hand, in Las Vegas, Nevada,
September 8 through 10, 2011.
Disclosure: The authors have no commercial asso-
ciations or financial interests to disclose.
Scotland, Iceland, Norway, and Austria).13As
such, Dupuytren’s disease has been labeled as the
“Viking” or “Nordic” disease, and the vast majority
of research has focused on its characterization in
these populations.10Interestingly, no objective sci-
entific evidence has been identified to confirm a
Nordic origin of the disease.10
Saboeiro et al.14published the racial distribu-
tion of Dupuytren’s disease prevalence in the U.S.
Department of Veterans Affairs patient popula-
tion. Their study revealed a prevalence rate of 130
per 100,000 blacks, 734 per 100,000 whites, 237
per 100,000 white Hispanics, 144 per 100,000 Na-
tive Americans, and 67 per 100,000 Asians. How-
ever, the Veterans Affairs patients are a unique
population and, as a result, may not accurately
represent the racial distribution of the disease.14
Furthermore, the authors did not comment on
the extent of the disease in Hispanics.
In our experience, we have anecdotally noted
an increased number of Hispanic patients with
Dupuytren’s disease, both in overall disease diag-
advanced disease. Thus, in this study, we sought to
determine the prevalence and operative rate of
Dupuytren’s disease in the Hispanic, black, white,
Asian, Native American, and other races and to
characterize the disease presentation in Hispanics
who required surgical treatment.
PATIENTS AND METHODS
A retrospective review of the Siemens Data
Warehouse, a database from the corporations bill-
ing system of Bellevue Hospital (New York, N.Y.),
was initially conducted to identify all self-reported
Hispanic, black, white, Asian, Native American,
and other race patients seen at Bellevue Hospital
for any medical condition between July of 2000
and August of 2010. From this data set, patients
with the diagnosis of Dupuytren’s disease were
selected by International Classification of Diseases,
Ninth Revision code. In addition, patients requir-
ing surgical correction of their disease were found
by Current Procedural Terminology code.
The Hispanic patients in this group were then
on the parameters of age, sex, ethnicity, hand
dominance, hand affected, and the digits that un-
derwent operative treatment. The following epi-
demiologic factors were also evaluated: smoking,
alcoholism, diabetes mellitus, hypercholesterol-
emia, epilepsy, and hypertension.
Data were expressed either as mean ? SD or
median and interquartile range. To evaluate the
relationship between Dupuytren’s disease preva-
lence or patients requiring surgery and race, chi-
square goodness-of-fit tests were used. To deter-
mine whether Dupuytren’s disease prevalence or
patients requiring surgery was significantly differ-
ent among the six races, Fisher’s exact tests were
carried out while maintaining a family error rate
of ? ? 0.05. To compare epidemiologic factors
among patients and those reported in the 2008
National Survey on Drug Use and Health, Wil-
coxon rank sum tests and one-proportion z tests
were performed, respectively. A one-proportion z
test is used to compare a sample proportion to a
proportion representative of a population. For all
A total of 2389 patients were assigned a diag-
nostic code for Dupuytren’s disease at Bellevue
Hospital between July 12, 2000, and August 10,
2010. Of these, 1177 patients (50.1 percent) were
seven (0.3 percent) were Native American, and
204 (8.7 percent) were of another race (Table 1).
Table 1. Racial Distribution of Dupuytren’s Disease
Operative Rate (%)
Plastic and Reconstructive Surgery • December 2011
During the same time, a total of 607,119 pa-
tients were seen at Bellevue Hospital. Therefore,
the overall prevalence of Dupuytren’s disease in
the study population is 387 per 100,000. Of the
panic; thus, the prevalence in Hispanic patients is
137,205 (294 per 100,000). The number of white
patients was 118,909 (304 per 100,000). The num-
(341 per 100,000). The number of other race pa-
tients was 58,144 (351 per 100,000).
Of the 2349 patients diagnosed with Du-
puytren’s disease during the study period, a total of
41 (1.7 percent) required surgical intervention. Of
these, 21 (51.2 percent) were Hispanic, two (4.9
percent) were black, 15 (36.6 percent) were white,
one (2.4 percent) was Asian, none were Native
American, and two (4.9 percent) were of another
race. Thus, the percentage of Dupuytren’s disease
patients requiring surgery was 1.8 percent in His-
0.5 percent in Asians, 0 percent in Native Amer-
icans, and 1.0 percent in those of another race.
A chi-square analysis revealed that both Du-
investigation, disease prevalence in Hispanics was
significantly greater than that in the other five races
(p ? 0.001). However, disease prevalence among
patients were not significantly different from each
other. In addition, the percentage of patients re-
quiring surgery was significantly greater for whites
Native American, and other races.
In the Hispanic subgroup of 21 patients, 18
were women (Table 2). The age at presentation
ranged from 42 to 73 years, with a mean of 59.9 ?
8.2 years. Sixteen of the patients had unilateral dis-
ease (76.2 percent) and five had bilateral disease
(23.8 percent). Two of the patients with bilateral
The average age at presentation for patients with
unilateral disease was 58.3 ? 8.2 years and that for
ment (56.3 percent) and seven had right hand in-
volvement (43.8 percent). The dominant hand was
affected in 10 patients with unilateral disease (62.5
The small finger was most commonly affected
(71.4 percent), followed by the ring finger (66.7
percent), the long finger (14.3 percent), the
thumb (4.8 percent), and the index finger (0 per-
cent). In patients who underwent surgery, the
mean metacarpophalangeal joint flexion contrac-
Table 2. Clinical Presentation of Dupuytren’s Disease in Hispanics Requiring Surgical Treatment
*Patients with bilateral disease who underwent unilateral surgery only.
R5, L4, L5
R4, R5, L3
Volume 128, Number 6 • Dupuytren’s Disease in Hispanics
ture was 47.8 ? 25.9 degrees and the mean prox-
imal interphalangeal joint flexion contracture was
42.8 ? 37.6 degrees.
The epidemiologic factors evaluated were
smoking (57.1 percent), hypertension (57.1 per-
cent), alcoholism (52.4 percent), diabetes melli-
tus (47.6 percent), hypercholesterolemia (19.0
percent), and epilepsy (0 percent). Overall, the
median number of comorbidities was 2 (inter-
quartile range, 2 to 3). The median number of
comorbidities was 2 (interquartile range, 2 to 2)
for patients with unilateral disease and 3.5 (inter-
quartile range, 3 to 4) for those with bilateral
disease. The median number of comorbidities was
2 (interquartile range, 2 to 3) for patients with
unilateral disease who had their dominant hand
affected and 2 (interquartile range, 2 to 2) for
those who had their nondominant hand affected.
bilateral disease was significantly greater than that
for those with unilateral disease (p ? 0.009). How-
ever, for patients with unilateral disease, the num-
ber of comorbidities for those who had their dom-
inant hand affected was not significantly different
from that for those who had their nondominant
Although its cause remains incompletely un-
derstood, Dupuytren’s disease is documented to
be strongly associated with genetic, geographic,
and environmental factors. To provide compre-
hensive and clinically accurate information to pa-
tients, epidemiologic information on disease dif-
ferences by race is important. Currently, the vast
majority of racial studies conducted on Du-
puytren’s disease have focused on northern Eu-
ropean whites in whom the disease is one of the
most commonly inherited connective tissue
The prevalence of Dupuytren’s disease in the
Hispanic population has only been studied once
in the literature and was found to be 237 per
prevalence in Hispanics to be 533 per 100,000,
which was statistically significantly greater than
Hospital patients (p ? 0.001). The discrepancy in
these estimates may be attributable to a unique
patient population in the U.S. Department of Vet-
erans Affairs, described as mainly male, poor, and
undereducated compared with the general U.S.
population.14In contrast, the patient population
of people in New York City as they presented to
Several differences between Dupuytren’s dis-
ease presentation in the Hispanic and white races
were identified in this study. Dupuytren’s disease
most often occurs bilaterally, with one hand being
more affected than the other. Hindocha et al.3
conducted a study in a large sample of white pa-
tients from northwest England and found that
69.4 percent of patients had bilateral disease. This
finding in whites is three-fold higher than that
determined by our study on Hispanic subjects
(23.8 percent), suggesting that bilateral disease
may be less common in Hispanics requiring sur-
gical correction of their Dupuytren’s disease than
in those of the white population (p ? 0.001).
Moreover, previous studies have reported that the
disease most commonly affects the ring finger,
followed by the small finger, thumb, and long and
index fingers, respectively.16However, in our
study, the Hispanic patients evaluated showed a
different order of digit involvement wherein the
small finger was most commonly affected, fol-
lowed by the ring finger, the long finger, the
thumb, and the index finger. Lastly, we deter-
mined the operative rate of patients to be twice as
high for whites as for Hispanics at 4.2 and 1.8
percent, respectively. Although in theory this dif-
severe in Hispanics than in whites, in practice the
decision to proceed with surgery reflects many
other factors such as cultural values and surgeon
bias for which this study was unable to account.
A number of epidemiologic factors have been
associated with the development of Dupuytren’s
disease. Six of these factors—smoking, alcohol-
ism, diabetes mellitus, hypercholesterolemia, ep-
ilepsy, and hypertension—were selected as evalu-
ation parameters on the basis of consistent
findings in the literature.13,15–20In patients with
percent rate of diabetes mellitus,13,17which is
thought to be attributable to the microangiopathy
and resulting increased collagen production.18In
our group of Hispanics who required surgical treat-
ment for their disease, 47.6 percent were diabetics
(p ? 0.05) compared with the upper limit specified
above, suggesting that diabetes as a comorbidity in
Caucasians with Dupuytren’s disease.
alcohol abuse and cigarette smoking have shown
an increased prevalence in patients with these
Plastic and Reconstructive Surgery • December 2011
comorbidities.15,19According to the 2008 National
Survey on Drug Use and Health, 4.1 percent of
U.S. Hispanics are classified as heavy alcohol
users.21However, among the Hispanic patients in
our study who required surgical treatment for
their disease, the rate of heavy alcohol use (52.4
percent) was increased nearly 13-fold (p ? 0.001).
three times higher than in nonsmokers, thought to
be related to the microvascular changes in the hand
Hispanics in the National Survey on Drug Use and
Health reported cigarette smoking compared with
57.1 percent of those we evaluated (p ? 0.001).
Considered together, these data strongly indicate
that alcoholism and smoking are comorbidities
more common in Hispanics with Dupuytren’s dis-
ease than in the general population.
Overall, 57.1 percent of the Hispanic patients
who required surgical treatment for Dupuytren’s
disease suffered from hypertension. Although hy-
pertension is well known to be associated with
smoking, 77.8 percent of nonsmokers with Du-
puytren’s disease had hypertension. This finding
supports the notion of hypertension as an inde-
pendent epidemiologic factor of the disease and,
perhaps, may be the mechanism through which
smoking leads to its pathophysiologic effects.
However, before conclusions may be drawn from
this hypothesis, further studies should be con-
hypertension and Dupuytren’s disease.
prevalence and such factors as epilepsy and anti-
convulsants has also been described.20However,
none of the subjects in our study sample who
required surgical correction for their disease had
been diagnosed with epilepsy.
Although the aforementioned clinical associ-
ations demonstrated statistically significant asso-
ciations with Dupuytren’s disease, it is important
to note that association does not imply causation.
As such, conclusions of causality should not be
drawn from these findings alone. In addition, al-
though this study was conducted on a large and
diverse patient population, it was confined to a
single center. These limitations should be consid-
ered when generalizing its results to the larger
In this study conducted on a racially diverse
patient population in New York City, we deter-
mined the prevalence of Dupuytren’s disease in
Hispanics to be 533 per 100,000, significantly
greater than that found in black (294 per
100,000), white (304 per 100,000), Asian (281 per
other (351 per 100,000) races.
Of the Hispanic patients, 1.8 percent required
surgery, 85.7 percent were male, and 14.3 percent
were female. Age at presentation ranged from 42
to 73 years, with a mean of 59.9 ? 8.2 years. In
addition, 76.2 percent had unilateral disease and
23.8 percent had bilateral disease. The small fin-
ger was most commonly affected (71.4 percent),
followed by the ring finger (66.7 percent), long
finger (14.3 percent), and thumb (4.8 percent),
and these patients were characterized by the
following comorbidities: smoking (57.1 per-
cent), hypertension (57.1 percent), alcoholism
(52.4 percent), diabetes mellitus (47.6 percent),
and hypercholesterolemia (19.0 percent). Al-
though the epidemiologic factors identified in
Hispanics with Dupuytren’s disease are similar
to those in other races investigated, this article
reports important differences with respect to
disease prevalence, clinical presentation, and
Sheel Sharma, M.D.
Department of Plastic Surgery
New York University Langone Medical Center
560 First Avenue, TH-169
New York, N.Y. 10016
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