Ivarsson A, Hernell O, Nyström L, Persson L A
Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden.
J Epidemiol Community Health. 2003 Jan;57(1):36-9. doi: 10.1136/jech.57.1.36.
Coeliac disease, also called permanent gluten sensitive enteropathy, is being recognised as a widespread health problem. Defining the possible role of environmental factors in its aetiology might open doors to primary prevention. This study therefore analysed if the risk for coeliac disease varies with month of birth as a proxy for a seasonal pattern for possible causal environmental exposure(s).
A population based incidence register of coeliac disease in children below 15 years of age covering the period from 1973 to 1997. Incidence rates were calculated by month of birth, stratified for age at diagnosis. Poisson regression analyses were used to estimate the relative risk for coeliac disease for children below 2 years of age by season of birth, also taking into account gender and time period of diagnosis.
Sweden.
All 2151 children in the study base with verified coeliac disease.
The risk for coeliac disease was significantly higher if born during the summer as compared with the winter (RR=1.4, 95% CI 1.2 to 1.7), but only in children below 2 years of age at diagnosis. This relative seasonal risk pattern prevailed during a 10 year epidemic of coeliac disease, although incidence rates varied threefold. The incidence was constantly higher among girls as compared with boys, but boys showed a more pronounced seasonal variation in risk than girls.
An increased coeliac disease risk in children born in the summer compared with the winter reflects causal environmental exposure(s) with a seasonal pattern. Infections might be the exposure of importance, either by means of a direct causal role and/or through interaction with other exposures, for example, gluten intake. However, non-infectious exposures should also be explored as possible contributing causal factors.
乳糜泻，也称为永久性麸质敏感肠病，正被视为一个广泛存在的健康问题。明确环境因素在其病因学中可能发挥的作用或许可为一级预防开辟道路。因此，本研究分析了乳糜泻风险是否会因出生月份不同而有所变化，以此作为可能的因果性环境暴露季节性模式的替代指标。
一项基于人群的1973年至1997年期间15岁以下儿童乳糜泻发病率登记研究。按出生月份计算发病率，并根据诊断时的年龄进行分层。采用泊松回归分析来估计2岁以下儿童按出生季节患乳糜泻的相对风险，同时考虑性别和诊断时间段。
瑞典。
研究数据库中所有2151名经证实患有乳糜泻的儿童。
与冬季出生的儿童相比，夏季出生的儿童患乳糜泻的风险显著更高（相对风险=1.4，95%可信区间1.2至1.7），但仅在诊断时年龄小于2岁的儿童中如此。这种相对的季节性风险模式在乳糜泻流行的10年期间一直存在，尽管发病率相差三倍。女孩的发病率始终高于男孩，但男孩的风险季节性变化比女孩更为明显。
与冬季出生的儿童相比，夏季出生的儿童患乳糜泻风险增加反映了具有季节性模式的因果性环境暴露。感染可能是重要的暴露因素，要么通过直接的因果作用，和/或通过与其他暴露因素相互作用，例如麸质摄入。然而，非感染性暴露也应作为可能的促成病因因素加以探索。
