Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, Montréal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada.
Prev Med. 2022 Jan;154:106893. doi: 10.1016/j.ypmed.2021.106893. Epub 2021 Nov 17.
The Bacillus Calmette-Guerin (BCG) vaccine could reduce the incidence of type 1 diabetes through non-specific immunomodulation. Previous epidemiological studies, presenting some limitations, report no association. We examined this association of early life BCG vaccination and age at vaccination with type 1 diabetes incidence in adolescence in a large representative cohort in Quebec. The cohort included 387,704 individuals born in Quebec between 1970 and 1974 whose BCG vaccination status was determined from a provincial registry. Individuals were followed up from 1985 to their 19th birthday (maximum to 1993) for their use of physician services. Individuals were defined as type 1 diabetes cases if they had ≥4 related physician claims over a 2-year period, with at least 30 days between two claims. Cox proportional hazards regression was used to estimate the association of BCG vaccination and age at vaccination with type 1 diabetes. Covariates were selected based on a directed acyclic graph. Interaction according to sex was evaluated. A total of 178,133 (45.9%) individuals were vaccinated and 442 (0.11%) incident cases of type 1 diabetes were identified. The risk of type 1 diabetes was similar in vaccinated compared with unvaccinated individuals (adjusted hazard ratio = 1.06 [95% CI: 0.88-1.29]). There was no association with age at vaccination, and results did not differ by sex (Interaction, p = 0.60). Our results suggest that BCG vaccination does not prevent type 1 diabetes in adolescence.
卡介苗（BCG）疫苗可通过非特异性免疫调节降低 1 型糖尿病的发病率。先前的流行病学研究报告存在一些局限性，表明两者之间并无关联。我们在魁北克省的一个大型代表性队列中，检查了 BCG 疫苗接种和接种年龄与青春期 1 型糖尿病发病之间的这种关联。该队列包括 1970 年至 1974 年期间在魁北克出生的 387704 人，其 BCG 疫苗接种状况从省级登记处确定。从 1985 年开始对个体进行随访，直至其 19 岁生日（最长随访至 1993 年），以了解其使用医生服务的情况。如果个体在 2 年内有≥4 次与糖尿病相关的医生就诊记录，且两次就诊之间至少间隔 30 天，则将其定义为 1 型糖尿病病例。使用 Cox 比例风险回归来估计 BCG 接种和接种年龄与 1 型糖尿病的关联。根据有向无环图选择协变量。评估了根据性别进行的交互作用。共有 178133 人（45.9%）接种了疫苗，发现了 442 例（0.11%）1 型糖尿病的新发病例。接种疫苗的个体与未接种疫苗的个体相比，1 型糖尿病的发病风险相似（调整后的危险比=1.06[95%CI：0.88-1.29]）。与接种年龄无关，并且结果不因性别而异（交互作用，p=0.60）。我们的结果表明，BCG 疫苗接种不能预防青春期 1 型糖尿病。
