Rostgaard Klaus, Kristjánsson Ragnar, Davidsson Olafur, Biel-Nielsen Dietz Jojo, Søegaard Signe Holst, Stensballe Lone Graff, Hjalgrim Henrik
Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark.
Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Front Epidemiol. 2025 Mar 12;5:1518559. doi: 10.3389/fepid.2025.1518559. eCollection 2025.
BACKGROUND: The probability of presenting with infectious mononucleosis (IM) upon primary Epstein-Barr virus infection increases dramatically at the start of puberty. Aiming to understand why that is, we assessed whether the number of infection-related health events during two specific time periods-ages 10-12 years (pre-teen window) and the three most recent years (recent window)-could predict the likelihood of individuals aged 13-19 years developing IM. METHODS: We used sibship-stratified Cox regression to mitigate socio-demographic confounding and bias. Consequently, we only followed members of IM-affected sibships aged 13-19 years between 1999 and 2021 for IM, based on information from complete nationwide Danish administrative and health registers. Estimates were further adjusted for sex, age, birth order (1, 2, 3+) and sibship constellation [number of siblings and their signed (older/younger) age difference to the index person]. Infection-related health events defining the exposures considered were either a category of antimicrobial prescription, or a hospital contact with an infectious disease diagnosis. We measured evidence/probability of the associations using asymptotic Bayes factors, rather than using -value based testing. RESULTS: The adjusted hazard ratio (HR) for IM with 95% confidence limits for an additional antimicrobial prescription in the pre-teen exposure window was [1.01; 0.98-1.04], and the corresponding adjusted HR for an additional antimicrobial prescription in the recent exposure window was [1.02; 0.99-1.06]. CONCLUSIONS: IM was not preceded by unusual numbers of infections. Small effect sizes, together with small variation in exposure, did not render the assessed exposures useful for predicting IM for public health or the clinic.
背景:初次感染爱泼斯坦-巴尔病毒后患传染性单核细胞增多症(IM)的概率在青春期开始时会急剧增加。为了解其中原因,我们评估了两个特定时间段(10至12岁,即儿童晚期;以及最近三年)内与感染相关的健康事件数量是否能够预测13至19岁个体患IM的可能性。 方法:我们采用同胞分层Cox回归来减轻社会人口学混杂因素和偏差。因此,基于丹麦全国完整的行政和健康登记信息,我们仅对1999年至2021年间13至19岁受IM影响的同胞家庭成员进行了IM随访。估计值进一步根据性别、年龄、出生顺序(1、2、3+)和同胞关系组合[兄弟姐妹数量及其与索引人物的有符号(年长/年幼)年龄差]进行了调整。定义所考虑暴露因素的与感染相关的健康事件要么是一类抗菌药物处方,要么是因传染病诊断而住院接触。我们使用渐近贝叶斯因子而非基于P值的检验来衡量关联的证据/概率。 结果:在儿童晚期暴露窗口中,额外一次抗菌药物处方导致IM的调整后风险比(HR)及其95%置信区间为[1.01;0.98 - 1.04],在最近暴露窗口中,额外一次抗菌药物处方导致IM的相应调整后HR为[1.02;0.99 - 1.06]。 结论:IM之前并没有异常数量的感染。效应量较小,加上暴露的变化较小,使得所评估的暴露因素对于预测公共卫生或临床中的IM并无用处。
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