Baker Julia M, Hasso-Agopsowicz Mateusz, Pitzer Virginia E, Platts-Mills James A, Peralta-Santos Andre, Troja Catherine, Archer Helena, Guo Boya, Sheahan William, Lingappa Jairam, Jit Mark, Lopman Benjamin A
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Vaccine Product Delivery Research, Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland.
Lancet Glob Health. 2021 Oct;9(10):e1402-e1410. doi: 10.1016/S2214-109X(21)00316-8.
The odds ratio (OR) comparing pathogen presence in diarrhoeal cases versus asymptomatic controls is a measure for diarrhoeal disease cause that has been integrated into burden of disease estimates across diverse populations. This study aimed to estimate the OR describing the association between pathogen detection in stool and diarrhoea for 15 common enteropathogens by age group and child mortality setting.
We did a systematic review to identify case-control and cohort studies published from Jan 1, 1990, to July 9, 2019, which examined at least one enteropathogen of interest and the outcome diarrhoea. The analytical dataset included data extracted from published articles and supplemented with data from the Global Enteric Multicenter Study and the Malnutrition and Enteric Disease study. Random effects meta-analysis models were fit for each enteropathogen, stratified by age group and child mortality level, and adjusted for pathogen detection method and study design to produce summary ORs describing the association between pathogen detection in stool and diarrhoea.
1964 records were screened and 130 studies (over 88 079 cases or diarrhoea samples and 135 755 controls or non-diarrhoea samples) were available for analysis. Heterogeneity (I) in unadjusted models was substantial, ranging from 27·6% to 86·6% across pathogens. In stratified and adjusted models, summary ORs varied by age group and setting, ranging from 0·4 (95% CI 0·2-0·6) for Giardia lamblia to 54·1 (95% CI 7·4-393·5) for Vibrio cholerae.
Incorporating effect estimates from diverse data sources into diarrhoeal disease cause and burden of disease models is needed to produce more representative estimates.
WHO, Bill & Melinda Gates Foundation, and National Institutes of Health.
比较腹泻病例与无症状对照中病原体存在情况的比值比（OR）是一种衡量腹泻病病因的指标，已被纳入不同人群疾病负担的估计中。本研究旨在按年龄组和儿童死亡率情况估计描述15种常见肠道病原体粪便中病原体检测与腹泻之间关联的OR。
我们进行了一项系统评价，以识别1990年1月1日至2019年7月9日发表的病例对照研究和队列研究，这些研究检测了至少一种感兴趣的肠道病原体以及腹泻结局。分析数据集包括从已发表文章中提取的数据，并补充了全球肠道多中心研究和营养不良与肠道疾病研究的数据。针对每种肠道病原体，采用随机效应荟萃分析模型，按年龄组和儿童死亡率水平进行分层，并对病原体检测方法和研究设计进行调整，以得出描述粪便中病原体检测与腹泻之间关联的汇总OR。
共筛选了1964条记录，有130项研究（超过88079例腹泻病例或样本以及135755例对照或非腹泻样本）可供分析。未调整模型中的异质性（I）很大，不同病原体的异质性范围为27.6%至86.6%。在分层和调整模型中，汇总OR因年龄组和情况而异，从蓝氏贾第鞭毛虫的0.4（95%CI 0.2 - 0.6）到霍乱弧菌的54.1（95%CI 7.4 - 393.5）不等。
需要将来自不同数据源的效应估计纳入腹泻病病因和疾病负担模型，以得出更具代表性的估计。
世界卫生组织、比尔及梅琳达·盖茨基金会和美国国立卫生研究院。
