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Rural and Urban Residence During Early Life is Associated with Risk of Inflammatory Bowel Disease: A Population-Based Inception and Birth Cohort Study


ABSTRACT:

Objectives

To determine the association between inflammatory bowel disease (IBD) and rural/urban household at the time of diagnosis, or within the first 5 years (y) of life.

Methods

Population-based cohorts of residents of four Canadian provinces were created using health administrative data. Rural/urban status was derived from postal codes based on population density and distance to metropolitan areas. Validated algorithms identified all incident IBD cases from administrative data (Alberta: 1999-2008, Manitoba and Ontario: 1999-2010, and Nova Scotia: 2000-2008). We determined sex-standardized incidence (per 100,000 patient-years) and incident rate ratios (IRR) using Poisson regression. A birth cohort was created of children in whom full administrative data were available from birth (Alberta 1996-2010, Manitoba 1988-2010, and Ontario 1991-2010). IRR was calculated for residents who lived continuously in rural/urban households during each of the first 5 years of life.

Results

There were 6,662 rural residents and 38,905 urban residents with IBD. Incidence of IBD per 100,000 was 33.16 (95% CI 27.24-39.08) in urban residents, and 30.72 (95% CI 23.81-37.64) in rural residents (IRR 0.90, 95% CI 0.81-0.99). The protective association was strongest in children <10 years (IRR 0.58, 95% CI 0.43-0.73) and 10-17.9 years (IRR 0.72, 95% CI 0.64-0.81). In the birth cohort, comprising 331 rural and 2,302 urban residents, rurality in the first 1-5 years of life was associated with lower risk of IBD (IRR 0.75-0.78).

Conclusions

People living in rural households had lower risk of developing IBD. This association is strongest in young children and adolescents, and in children exposed to the rural environment early in life.

SUBMITTER: Benchimol EI 

PROVIDER: S-EPMC5596205 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Rural and Urban Residence During Early Life is Associated with Risk of Inflammatory Bowel Disease: A Population-Based Inception and Birth Cohort Study

Benchimol Eric I EI   Kaplan Gilaad G GG   Otley Anthony R AR   Nguyen Geoffrey C GC   Underwood Fox E FE   Guttmann Astrid A   Jones Jennifer L JL   Potter Beth K BK   Catley Christina A CA   Nugent Zoann J ZJ   Cui Yunsong Y   Tanyingoh Divine D   Mojaverian Nassim N   Bitton Alain A   Carroll Matthew W MW   deBruyn Jennifer J   Dummer Trevor J B TJB   El-Matary Wael W   Griffiths Anne M AM   Jacobson Kevan K   Kuenzig M Ellen ME   Leddin Desmond D   Lix Lisa M LM   Mack David R DR   Murthy Sanjay K SK   Sánchez Juan Nicolás Peña JNP   Singh Harminder H   Targownik Laura E LE   Vutcovici Maria M   Bernstein Charles N CN  

The American journal of gastroenterology 20170725 9


<h4>Objectives</h4>To determine the association between inflammatory bowel disease (IBD) and rural/urban household at the time of diagnosis, or within the first 5 years (y) of life.<h4>Methods</h4>Population-based cohorts of residents of four Canadian provinces were created using health administrative data. Rural/urban status was derived from postal codes based on population density and distance to metropolitan areas. Validated algorithms identified all incident IBD cases from administrative dat  ...[more]

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