Esophageal eosinophilia is increased in rural areas with low population density: results from a national pathology database.
Esophageal eosinophilia is increased in rural areas with low population density: results from a national pathology database.
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DOI：
10.1038/ajg.2014.47
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发表时间：
2014-05
期刊：
影响因子：
--
通讯作者：
Dellon ES
中科院分区：
文献类型：
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作者：
Jensen ET;Hoffman K;Shaheen NJ;Genta RM;Dellon ES
嗜酸性食管炎（EoE）是一种越来越普遍的慢性疾病，由过敏/免疫介导的过程引起。一般来说，特应性疾病的风险在农村和城市环境中不同。人口密度和EoE之间的关系尚不清楚。我们的目的是评估EoE和人口密度之间的关系。我们对2009年1月至2012年6月美国国家病理学数据库中食管活检患者进行了一项横断面病例对照研究，以评估人口密度与EoE之间的关系。使用地理信息系统（GIS），人口密度（个人/英里2），确定每个患者的邮政编码。食管嗜酸性粒细胞增多症和EoE的几率估计为每五分之一的人口密度，并调整潜在的混杂因素。对不同的病例定义进行了敏感性分析，以评价内镜检查量和患者因素造成偏倚的可能性。在源人群的292，621例独特患者中，89，754例食管活检正常，14，381例食管嗜酸性粒细胞增多，每个高倍视野（eos/hpf）≥15个嗜酸性粒细胞。食管嗜酸性粒细胞增多的几率随着人口密度的降低而增加（趋势p < 0.001）。与人口密度最高五分位数的人群相比，人口密度最低五分位数人群中食管嗜酸性粒细胞增多的几率显著更高（aOR 1.27，95% CI：1.18，1.36）。在病例定义中观察到相似的剂量-反应趋势，在最低人口密度五分位数中EoE的几率增加（aOR 1.59，95% CI：1.45-1.76）。估计值对敏感性分析具有稳健性。人口密度与食管嗜酸性粒细胞增多和EoE呈强负相关。这种关联对于不同的病例定义和调整因子是稳健的。在农村地区更为突出的环境暴露可能与EoE的发病机制有关。
Eosinophilic esophagitis (EoE) is an increasingly prevalent chronic disease arising from an allergy/immune-mediated process. Generally, the risk of atopic disease differs in rural and urban environments. The relationship between population density and EoE is unknown. Our aim was to assess the relationship between EoE and population density. : We conducted a cross-sectional, case-control study of patients with esophageal biopsies in a U.S. national pathology database between January 2009 and June 2012 to assess the relationship between population density and EoE. Using Geographic Information Systems (GIS), the population density (individuals/mile2) was determined for each patient zip code. The odds of esophageal eosinophilia and EoE were estimated for each quintile of population density and adjusted for potential confounders. Sensitivity analyses were conducted with varying case definitions and to evaluate the potential for bias from endoscopy volume and patient factors. Of 292,621 unique patients in the source population, 89,754 had normal esophageal biopsies and 14,381 had esophageal eosinophilia with ≥15 eosinophils per high-power field (eos/hpf). The odds of esophageal eosinophilia increased with decreasing population density (p for trend < 0.001). Compared to those in the highest quintile of population density, odds of esophageal eosinophilia were significantly higher amongst those in the lowest quintile of population density (aOR 1.27, 95% CI: 1.18, 1.36). A similar dose-response trend was observed across case definitions with odds of EoE increased in the lowest population density quintile (aOR 1.59, 95% CI: 1.45-1.76). Estimates were robust to sensitivity analyses. Population density is strongly and inversely associated with esophageal eosinophilia and EoE. This association is robust to varying case definitions and adjustment factors. Environmental exposures more prominent in rural areas may be relevant to the pathogenesis of EoE.