贾第虫病与后续的肠易激综合征：一项使用健康保险数据的纵向队列研究。

Giardiasis and Subsequent Irritable Bowel Syndrome: A Longitudinal Cohort Study Using Health Insurance Data.

作者信息

Nakao Jolene H, Collier Sarah A, Gargano Julia W

机构信息

Epidemic Intelligence Service, Epidemiology Workforce Branch, Division of Scientific Education And Professional Development, Center For Surveillance, Epidemiology And Laboratory Services, Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

出版信息

J Infect Dis. 2017 Mar 1;215(5):798-805. doi: 10.1093/infdis/jiw621.

DOI:10.1093/infdis/jiw621

PMID:28329069

Abstract

BACKGROUND

Giardia intestinalis is the most commonly reported human intestinal parasite in the United States. Increased incidence of chronic gastrointestinal complaints has been reported after some giardiasis outbreaks. We examined the relationship between giardiasis diagnosis and irritable bowel syndrome (IBS) diagnosis.

METHODS

We used the 2006-2010 MarketScan commercial insurance database. Persons with at least 1 giardiasis diagnosis were individually matched on age group, sex, and enrollment length in months to 5 persons without a giardiasis diagnosis. Persons diagnosed with IBS before the date of study entry were excluded. We calculated crude incidence rates (IRs) and developed Cox proportional hazards models.

RESULTS

The matched cohort included 3935 persons with giardiasis and 19663 persons without giardiasis. One-year incidence of IBS was higher in persons with giardiasis (IR = 37.7/1000 person-years vs 4.4/1000 person-years). The unadjusted hazard ratio was 4.8 (95% confidence interval [CI] = 3.6-6.4), attenuated slightly to 3.9 (95% CI = 2.9-5.4) after adjusting for anxiety, depression, and healthcare utilization.

CONCLUSIONS

In a large insurance database, individuals diagnosed with giardiasis were more likely to have a subsequent IBS diagnosis, despite accounting for confounders. Future research on risk factors for IBS among giardiasis patients and the pathophysiology of postinfectious IBS is needed.

摘要

背景

在美国，肠道贾第虫是报告最多的人体肠道寄生虫。据报道，在一些贾第虫病暴发后，慢性胃肠道不适的发病率有所上升。我们研究了贾第虫病诊断与肠易激综合征（IBS）诊断之间的关系。

方法

我们使用了2006 - 2010年市场扫描商业保险数据库。至少有1次贾第虫病诊断的人，按年龄组、性别和参保月数，与5名无贾第虫病诊断的人进行个体匹配。在研究入组日期之前被诊断为IBS的人被排除。我们计算了粗发病率（IRs）并建立了Cox比例风险模型。

结果

匹配队列包括3935名患有贾第虫病的人和19663名无贾第虫病的人。贾第虫病患者的IBS一年发病率更高（IR = 37.7/1000人年，而无贾第虫病者为4.4/1000人年）。未调整的风险比为4.8（95%置信区间[CI] = 3.6 - 6.4），在对焦虑、抑郁和医疗利用情况进行调整后，略有下降至3.9（95% CI = 2.9 - 5.4）。