Ivarsson Anneli, Persson Lars Ake, Nyström Lennarth, Hernell Olle
Department of Clinical Sciences, Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden.
Eur J Epidemiol. 2003;18(7):677-84. doi: 10.1023/a:1024873630588.
In the mid 1980s the incidence of coeliac disease in Swedish children below 2 years of age increased threefold within a few years, and after a 10-year high incidence period returned equally rapidly to the previous level. Analysing the epidemic with respect to any change in female to male ratio over time, or shift in age at diagnosis, may increase the understanding of coeliac disease aetiology. In a population-based incidence study of childhood coeliac disease, 2151 cases (811 boys/1340 girls) were diagnosed from 1973 to 1997. Incidence rates and relative risks (RRs) were calculated by gender, age at diagnosis and calendar time. Cumulative incidences by age and gender were calculated for different birth cohorts. A twofold higher risk (RR: 1.9, 95% confidence interval (CI) 1.7-2.1) for coeliac disease in girls as compared to boys prevailed throughout the epidemic. Further, during the post-epidemic period there was an upward shift in age at diagnosis. So far, however, a majority of the cases diagnosed at older ages belong to birth cohorts of the epidemic period, i.e. cohorts that already had a high coeliac disease risk before 2 years of age. Our results suggest that girls as compared to boys may be genetically more vulnerable to environmental exposures influencing the immunological processes towards coeliac disease. Further, an increased risk for coeliac disease during the first years of life due to, for example, unfavourable infant dietary habits, may result in an increased total childhood risk for coeliac disease. A longer follow-up, even into adulthood, is needed to determine whether or not the lifetime risk has changed.
20世纪80年代中期，瑞典2岁以下儿童腹腔疾病的发病率在几年内增长了两倍，在经历了10年的高发期后，又同样迅速地恢复到先前水平。分析该流行病在不同时间的男女比例变化或诊断年龄的变化，可能会增进对腹腔疾病病因的理解。在一项基于人群的儿童腹腔疾病发病率研究中，1973年至1997年期间共诊断出2151例病例（811名男孩/1340名女孩）。根据性别、诊断年龄和日历时间计算发病率和相对风险（RR）。计算了不同出生队列按年龄和性别的累积发病率。在整个流行期间，女孩患腹腔疾病的风险比男孩高出两倍（RR：1.9，95%置信区间（CI）1.7 - 2.1）。此外，在流行后期，诊断年龄出现了上升趋势。然而，到目前为止，大多数在较大年龄诊断出的病例属于流行期的出生队列，即在2岁之前就已经有较高腹腔疾病风险的队列。我们的结果表明，与男孩相比，女孩在基因上可能更容易受到影响腹腔疾病免疫过程的环境暴露因素的影响。此外，例如由于不良的婴儿饮食习惯，在生命最初几年患腹腔疾病的风险增加，可能会导致儿童期患腹腔疾病的总风险增加。需要更长时间的随访，甚至到成年期，以确定终身风险是否发生了变化。
