Int J Health Geogr - Geographical variation of Crohn's disease residual incidence in the Province of Quebec, Canada.

Tópicos

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Resumo

CKGROUND: Crohn's disease (CD) is clinically expressed as a chronic affection of the gastrointestinal tract currently known to have a multifactorial etiology involving a complex pathophysiological host response modulated by genetic susceptibilities, demographic determinants and environmental factors. With more than 20 cases per 100,000 person-years, the province of Quebec, Canada is among regions of the world with highest reported occurrence of CD in relation to other places where comparable estimates are available. This ecological study was designed to provide a medium-scale spatial exploration of CD incidence after accounting for the influence of known population and regional determinants. Health records of consulting patients in southern Quebec were compiled from 1995 to 2000 and used to estimate age and sex standardized rates per health area (n = 156). Various statistical models taking into account the regional effect of Jewish ethnicity, aboriginal ancestry, material deprivation, prescription for oral contraceptives, reportable enteric infection incidence, smoking as well as latitude and longitude locations were fitted.RESULTS: The final regression model presented a coefficient of determination of 22.8% and there was evidence of an eastern trend in the residual incidence (p = 0.018). Overall, the smoothed residual incidence presented a heterogeneous spatial pattern with evidence of patches (multiple health areas) of high, low and contrasting values. Health areas with most extreme incidence residuals where also distributed over the whole province including one area in the metropolitan area of Montreal and others in surrounding areas.CONCLUSIONS: These findings suggest that known populational and regional factors derived through census information only explain a limited fraction of the geographical variation of CD incidence and lead to speculate that the effects of these factors may be incompletely captured (imperfect construction of proxy variables) or that other important factors remain unmeasured. In this view, markers of genetic profiles of homogeneous sub-populations, and other factors linked to agroenvironmental microbial exposure should be further investigated. Once accounting for known factors, it would also be worth comparing adjacent geographical areas demonstrating abrupt changes in residual incidence rates to further explore effect linked to regional factors from those resulting from various reporting systems.

Resumo Limpo

ckground crohn diseas cd clinic express chronic affect gastrointestin tract current known multifactori etiolog involv complex pathophysiolog host respons modul genet suscept demograph determin environment factor case per personyear provinc quebec canada among region world highest report occurr cd relat place compar estim avail ecolog studi design provid mediumscal spatial explor cd incid account influenc known popul region determin health record consult patient southern quebec compil use estim age sex standard rate per health area n various statist model take account region effect jewish ethnic aborigin ancestri materi depriv prescript oral contracept report enter infect incid smoke well latitud longitud locat fittedresult final regress model present coeffici determin evid eastern trend residu incid p overal smooth residu incid present heterogen spatial pattern evid patch multipl health area high low contrast valu health area extrem incid residu also distribut whole provinc includ one area metropolitan area montreal other surround areasconclus find suggest known popul region factor deriv census inform explain limit fraction geograph variat cd incid lead specul effect factor may incomplet captur imperfect construct proxi variabl import factor remain unmeasur view marker genet profil homogen subpopul factor link agroenvironment microbi exposur investig account known factor also worth compar adjac geograph area demonstr abrupt chang residu incid rate explor effect link region factor result various report system

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