1985 1992 1996 1997 1998 1999 2000 2002 2003 Year

Figure 2 Estimated growth in point prevalence (amount of feeding taking place at a given point in time) in home enteral tube feeding (HETF) and home parenteral nutrition (HPN) in the United Kingdom.

feeding companies. In many developed countries there is considerably more ETF taking place in the community than in hospital. In Britain, there continues to be steady growth (10-20% per year) in the numbers of people receiving HETF, and in 2003, 21 527 people were registered with the British Artificial Nutrition Survey (BANS), with an estimated total number receiving HETF in excess of 25 000. As with HPN, HETF is less common in Europe than in North America and is practised much less in Eastern Europe, India, and China than in industrialized Western countries.

In addition to the differences in prevalence of HETF and HPN between countries, there may also be marked variations within countries. Even within one region of the United Kingdom (south and west regions) the number of individuals receiving HETF in 2002 within different primary care trusts varied from 82 to 632 per 1 million people. Similarly, considerable variation in the point prevalence of HPN was found to exist in different regions of the United Kingdom in 1999 (0 to 36per 1 million). This large variation, which is unlikely to be due to chance, can be explained by variations in the availability of expertise and support staff, resources to fund such treatment, or local differences in attitudes/policies toward the use of artificial nutrition.

The wide variations in the prevalence of home artificial feeding throughout the world are related to health care economies. There is a relationship between expenditure on health care, as a percentage of gross domestic product (GDP), and the incidence of HPN and HETF. In India, Pakistan, and Africa, where spending on health is low, home artificial nutrition is less common. In Western Europe, where health care accounts for a greater proportion of GDP, home artificial nutritional support is more common. In the United States, with an even greater expenditure on health care, the prevalence of HPN and HETF is higher than anywhere else in the world.

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