Dan O'Neill

Prevalence and risk factors for canine epilepsy of unknown origin in the UK

Epidemiological evaluation of canine epilepsy is an under-researched area. The objectives of this study were to estimate prevalence and investigate risk factors for epilepsy of unknown origin (EUO) among dogs attending primary veterinary practices in the UK. The clinical data analysed spanned a two-year period and included all dogs attending 92 primary veterinary clinics participating in the VetCompass project. Five hundred and thirty-nine EUO cases were identified giving a prevalence of 0.62% (95% CI 0.57% to 0.67%). Males were over 1.5 times as likely to have EUO compared with females (95% CI 1.44 to 2.06; P < 0.001). Of purebred dogs, the border terrier had 2.70 (95% CI 1.57 to 4.62; P < 0.001) and the German shepherd dog had 1.90 (95% CI 1.28 to 2.80; P=0.001) times increased odds of EUO compared with crossbred dogs. In addition, the West Highland white terrier had reduced odds (OR 0.23; 95% CI 0.08 to 0.62; P=0.004) of EUO compared with crossbred dogs (likelihood ratio test P < 0.0001). No association was found with neuter status, colour or weight. The current study highlights the clinical importance of epilepsy as a canine disorder in the UK. Increased awareness of sex and breed predispositions may assist clinicians with diagnosis. Further research is merited to evaluate the specific breed associations identified.

Prevalence of disorders recorded in cats attending primary-care veterinary practices in England

Improved understanding of absolute and relative prevalence values for common feline disorders could support clinicians when listing differential diagnoses and also assist prioritisation of breeding, research and health control strategies. This study aimed to analyse primary-care veterinary clinical data within the VetCompass project to estimate the prevalence of the most common disorders recorded in cats in England and to evaluate associations with purebred status. It was hypothesised that common disorders would be more prevalent in purebred than in crossbred cats. From a study population of 142,576 cats attending 91 clinics across Central and South-East England from 1 September 2009 to 15 January 2014, a random sample of 3584 was selected for detailed clinical review to extract information on all disorders recorded. The most prevalent diagnosis-level disorders were periodontal disease (n = 499; prevalence, 13.9%, 95% confidence intervals [CI], 12.5-15.4), flea infestation (n = 285; prevalence, 8.0%; 95% CI, 7.0-8.9) and obesity (n = 239; prevalence, 6.7%; 95% CI, 5.7-7.6). The most prevalent disorder groups recorded were dental conditions (n = 540; prevalence, 15.1%, 95% CI, 13.6-16.6), traumatic injury (n = 463; prevalence, 12.9%; 95% CI, 11.6-14.3) and dermatological disorders (n = 373; prevalence, 10.4%; 95% CI, 9.2-11.7). Crossbred cats had a higher prevalence of abscesses (excluding cat bite abscesses) (P = 0.009) and hyperthyroidism (P = 0.002) among the 20 most common disorders recorded. Purebreds had a higher prevalence for coat disorders (P <0.001). Veterinarians could use these results to focus their diagnostic and prophylactic efforts towards the most prevalent feline disorders. The study did not show an increased prevalence of common disorders in purebred cats compared with crossbred cats. Primary-care veterinary clinical data were versatile and useful for demographic and clinical feline studies.

Chronic Kidney Disease in Dogs in UK Veterinary Practices: Prevalence, Risk Factors, and Survival

BACKGROUND The prevalence for chronic kidney disease (CKD) in dogs varies widely (0.05-3.74%). Identified risk factors include advancing age, specific breeds, small body size, and periodontal disease. HYPOTHESIS/OBJECTIVES To estimate the prevalence and identify risk factors associated with CKD diagnosis and survival in dogs. Purebred dogs were hypothesized to have higher CKD risk and poorer survival characteristics than crossbred dogs. ANIMALS A merged clinical database of 107,214 dogs attending 89 UK veterinary practices over a 2-year period (January 2010-December 2011). METHODS A longitudinal study design estimated the apparent prevalence (AP) whereas the true prevalence (TP) was estimated using Bayesian analysis. A nested case-control study design evaluated risk factors. Survival analysis used the Kaplan-Meier survival curve method and multivariable Cox proportional hazards regression modeling. RESULTS The CKD AP was 0.21% (95% CI: 0.19-0.24%) and TP was 0.37% (95% posterior credibility interval 0.02-1.44%). Significant risk factors included increasing age, being insured, and certain breeds (Cocker Spaniel, Cavalier King Charles Spaniel). Cardiac disease was a significant comorbid disorder. Significant clinical signs included halitosis, weight loss, polyuria/polydipsia, urinary incontinence, vomiting, decreased appetite, lethargy, and diarrhea. The median survival time from diagnosis was 226 days (95% CI 112-326 days). International Renal Interest Society stage and blood urea nitrogen concentration at diagnosis were significantly associated with hazard of death due to CKD. CONCLUSIONS AND CLINICAL IMPORTANCE Chronic kidney disease compromises dog welfare. Increased awareness of CKD risk factors and association of blood biochemistry results with survival time should facilitate diagnosis and optimize case management to improve animal survival and welfare.

An epidemiological study of diabetes mellitus in dogs attending first opinion practice in the UK

This study aimed to estimate the prevalence of canine diabetes mellitus (DM) in primary-care clinics in England, to identify risk factors associated with DM and to describe the survival of affected dogs. Cases of DM were identified within the electronic patient records of 89 small-animal practices. A nested case–control study identified risk factors for the diagnosis of DM using logistic regression models. Cox proportional hazards models were used to analyse variables associated with survival. Four-hundred and thirty-nine canine DM cases were identified, giving an apparent prevalence of 0.34% (95% CI 0.31% to 0.37%). Neutered males were at an increased risk of diabetes compared with entire males, whereas neutering was not associated with DM in females. When compared with crossbred dogs, Yorkshire terriers had increased odds, whereas German shepherd dogs and golden retrievers had lower odds of DM. Being classified as overweight and having a diagnosis of pancreatitis, hyperadrenocorticism or a urinary tract infection were positively associated with DM. Older dogs and those diagnosed with pancreatitis had a higher hazard of death, whereas insured and neutered dogs had a lower hazard. This study provides an objective assessment of canine DM using primary-care veterinary practice data and is a valuable benchmark against which future epidemiological trends in DM can be assessed and improvements in the management of DM in primary-care practice can be judged.

Prevalence of and Risk Factors for Degenerative Mitral Valve Disease in Dogs Attending Primary-care Veterinary Practices in England

Background To date, epidemiological studies on degenerative mitral valve disease (DMVD) in dogs have largely reported referral caseloads or been limited to predisposed breeds. Analysis of primary‐care data to identify factors associated with DMVD would help clinicians identify high‐risk individuals and improve understanding. Objectives To estimate the prevalence of and identify risk factors for DMVD in dogs attending primary‐care veterinary practices in England. Animals Cases were identified within the electronic patient records of 111,967 dogs attending 93 practices. Four hundred and 5 dogs were diagnosed with DMVD (diagnosed cases) and a further 3,557 dogs had a heart murmur (HM) consistent with DMVD (possible cases). Methods Retrospective cross‐sectional study design. Prevalence was adjusted for the sampling approach. Mixed effects logistic regression models identified factors associated with DMVD. Results Prevalence estimates of diagnosed DMVD and HMs consistent with DMVD (both diagnosed and possible cases) were 0.36% (95% confidence interval [CI]: 0.29–0.45) and 3.54% (95% CI: 3.26–3.84) respectively. In the multivariable analysis, males had higher odds of diagnosed DMVD than did females (odds ratio [OR] 1.40, 95% CI: 1.12–1.74). Insured dogs had increased odds of DMVD compared with noninsured dogs (OR 3.56, 95% CI: 2.79–4.55) and dogs ≥20 kg had approximately half the odds of DMVD diagnosis compared with dogs <20 kg (OR 0.51, 95% CI: 0.36–0.74). Strong associations between a DMVD diagnosis and individual breeds and age were identified. Conclusions and Clinical Importance Degenerative mitral valve disease was a common disorder in practice‐attending dogs. Knowledge of identified risk factors for DMVD could improve clinical diagnosis and direct future research.

Epidemiology of hyperadrenocorticism among 210,824 dogs attending primary-care veterinary practices in the UK from 2009 to 2014.

OBJECTIVES To estimate prevalence and risk factors for diagnosis with hyperadrenocorticism in dogs attending primary-care veterinary practices in the UK from 2009 to 2014. METHODS Cases were identified by searching the de-identified electronic patient records from UK primary-care veterinary practices participating in the VetCompass Programme. RESULTS The estimated prevalence for hyperadrenocorticism diagnosis in dogs was 0·28% (95% confidence interval: 0·25 to 0·31). Multivariable logistic regression analysis revealed four associated risk factors: breed, breed-relative bodyweight, age and insurance status. The bichon frise had 6·5 times the odds (95% CI: 3·5 to 12·1, P<0·001) of hyperadrenocorticism compared with crossbreds. Dogs weighing more than or equal to their breed mean had 1·7 times the odds (95% CI: 1·3 to 2·3, P<0·001) of hyperadrenocorticism compared with dogs weighing less than the breed mean. Dogs aged 12·0 years and above showed 5·7 times the odds (95% CI: 3·7 to 8·7, P<0·001) of hyperadrenocorticism compared with dogs aged 6·0 to 8·9 years. Insured dogs had 4·0 times the odds (95% CI: 2·8 to 5·6, P<0·001) of hyperadrenocorticism compared with non-insured dogs. CLINICAL SIGNIFICANCE This is the first epidemiological report of a non-referral hospital population of dogs diagnosed with hyperadrenocorticism in the UK and describes important breed, age and bodyweight associations with this disorder which may improve diagnosis and enhance understanding of the underlying pathophysiology.

Feline hyperthyroidism reported in primary-care veterinary practices in England: prevalence, associated factors and spatial distribution

Feline hyperthyroidism is a commonly diagnosed endocrinopathy that can have a substantial deleterious impact on the welfare of affected cats. This study aimed to estimate the prevalence, associated factors and geographical distribution for feline hyperthyroidism in England, using primary-care veterinary practice clinical data from the VetCompass Animal Surveillance Project. Prevalence was estimated from the overall cat cohort. Associated factor analysis used an age-matched, nested, case-control design with multivariable logistic regression. There were 2,276 cases of feline hyperthyroidism identified from 95,629 cats attending 84 practices from September 2009 to December 2011. Cases were aged 6–25 years. 3.7 per cent of cases and 9.9 per cent of controls were purebred, 56.4 per cent of cases and 56.5 per cent of controls were female, and 88.1 per cent of cases and 86.0 per cent of controls were neutered. The apparent prevalence was 2.4 per cent (95% CI 2.3 to 2.5 per cent) overall, and 8.7 per cent (95% CI 8.3 to 9.0 per cent) in cats aged 10 years or above. Burmese (OR 0.15, 95% CI 0.07 to 0.32, P<0.0001), Persian (OR 0.17, 95% CI 0.08 to 0.33, P<0.0001), Siamese (OR 0.4, 95% CI 0.21 to 0.75, P=0.004) and purebred cats overall (OR 0.33, 95% CI 0.25 to 0.42, P< 0.0001) had lower odds of feline hyperthyroidism than non-purebred cats. Insured cats had increased odds (OR 1.78, 95% CI 1.56 to 2.03, P< 0.001). There was little evidence of spatial variation. This study highlights feline hyperthyroidism as a high-prevalence disease in England, and reports reduced odds of diagnosis in certain breeds and purebred cats overall.

Epidemiology of Diabetes Mellitus among 193,435 Cats Attending Primary‐Care Veterinary Practices in England

Background Diabetes mellitus (DM) is a common endocrine disease of cats. The prevalence of DM in cats in England is not well‐defined. Hypothesis/Objectives To estimate the prevalence and identify risk factors for DM in a large population of cats attending primary‐care practices. Animals A cohort of 193,563 cats in the VetCompass Programme attending 118 primary‐care practices in England. Methods Cross‐sectional analysis of cohort clinical data. Data were extracted covering September 1st 2009 and August 31st 2014. Period prevalence of DM was calculated. Associations between risk factors and DM were assessed using logistic regression modelling. Results Of 1,128 DM cases were identified among 194,563 cats (period prevalence 0.58%; 95% confidence interval [CI] 0.54–0.61). Multivariable modelling indicated that Tonkinese (OR 4.1; 95% CI 1.8–9.6; P = .001), Norwegian Forest (odds ratio [OR] 3.5; 95% CI 1.3–9.6; P = .001) and Burmese (OR 3.0; 95% CI 2.0–4.4; P < .001) cats had increased odds of DM compared with crossbred cats. DM odds increased as bodyweight categories increased above 4 kg (P < .001), as cats aged beyond 6 years old (P < .001) and in insured cats (OR 2.0; 95% CI 1.6–2.4; P < .001) but sex was not significantly associated with DM. Conclusions and Clinical Importance Diabetes mellitus is an important component of the primary‐care practice caseload with 1‐in‐200 cats affected. An increased risk of DM in certain cat breeds supports a genetic predisposition. These results can guide future research and preventative healthcare.

Epidemiology of Cranial Cruciate Ligament Disease Diagnosis in Dogs Attending Primary‐Care Veterinary Practices in England

OBJECTIVE To estimate the prevalence and risk factors for a diagnosis of cranial cruciate ligament (CCL) disease in dogs and to describe the management of such cases attending primary-care veterinary practices. STUDY DESIGN Historical cohort with a nested case-control study. SAMPLE POPULATION Nine hundred and fifty-three dogs diagnosed with CCL disease from 171,522 dogs attending 97 primary-care practices in England. METHODS Medical records of dogs attending practices participating in the VetCompass project that met selection criteria were assessed. Univariate and multivariate logistic regression methods were used to evaluate association of possible risk factors with diagnosis of CCL disease. RESULTS The prevalence of CCL disease diagnosis was estimated at 0.56% (95% confidence interval 0.52-0.59). Compared with crossbred dogs, Rottweilers, West Highland White Terriers, Golden Retrievers, Yorkshire Terriers, and Staffordshire Bull Terriers showed increased odds of CCL disease diagnosis while Cocker Spaniels showed reduced odds. Increasing bodyweight within breeds was associated with increased odds of diagnosis. Dogs aged over 3 years had increased odds of diagnosis compared with dogs aged less than 3 years. Neutered females had 2.1 times the odds of diagnosis compared with entire females. Insured dogs had 4 times the odds of diagnosis compared with uninsured dogs. Two-thirds of cases were managed surgically, with insured and heavier dogs more frequently undergoing surgery. Overall, 21% of cases were referred, with referral more frequent in heavier and insured dogs. Referred dogs more frequently had surgery and an osteotomy procedure. CONCLUSION Breed predispositions and demographic factors associated with diagnosis and case management of CCL disease in dogs identified in this study can be used to help direct future research and management strategies.

Characterisation of antimicrobial usage in cats and dogs attending UK primary care companion animal veterinary practices

There is scant evidence describing antimicrobial (AM) usage in companion animal primary care veterinary practices in the UK. The use of AMs in dogs and cats was quantified using data extracted from 374 veterinary practices participating in VetCompass. The frequency and quantity of systemic antibiotic usage was described. Overall, 25 per cent of 963,463 dogs and 21 per cent of 594,812 cats seen at veterinary practices received at least one AM over a two-year period (2012–2014) and 42 per cent of these animals were given repeated AMs. The main agents used were aminopenicillin types and cephalosporins. Of the AM events, 60 per cent in dogs and 81 per cent in cats were AMs classified as critically important (CIAs) to human health by the World Health Organisation. CIAs of highest importance (fluoroquinolones, macrolides, third-generation cephalosporins) accounted for just over 6 per cent and 34 per cent of AMs in dogs and cats, respectively. The total quantity of AMs used within the study population was estimated to be 1473 kg for dogs and 58 kg for cats. This study has identified a high frequency of AM usage in companion animal practice and for certain agents classified as of critical importance in human medicine. The study highlights the usefulness of veterinary practice electronic health records for studying AM usage.