Association of enteropathogen detection with diarrhoea by age and high versus low child mortality settings: a systematic review and meta-analysis.
Association of enteropathogen detection with diarrhoea by age and high versus low child mortality settings: a systematic review and meta-analysis.
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DOI：
10.1016/s2214-109x(21)00316-8
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发表时间：
2021-10
期刊：
影响因子：
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通讯作者：
Lopman BA
中科院分区：
文献类型：
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作者：
Baker JM;Hasso-Agopsowicz M;Pitzer VE;Platts-Mills JA;Peralta-Santos A;Troja C;Archer H;Guo B;Sheahan W;Lingappa J;Jit M;Lopman BA
比较肠道病例与无症状对照中病原体存在的比值比（OR）是肠道疾病原因的一种衡量标准，已被纳入不同人群的疾病负担估计中。本研究的目的是估计OR，描述粪便中病原体检测与腹泻之间的相关性，按年龄组和儿童死亡率设置15种常见肠道病原体。我们进行了一项系统性综述，以确定1990年1月1日至2019年7月9日发表的病例对照和队列研究，这些研究检查了至少一种感兴趣的肠道病原体和腹泻结局。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和肠道疾病研究的数据。随机效应荟萃分析模型适用于每种肠道病原体，按年龄组和儿童死亡率水平分层，并根据病原体检测方法和研究设计进行调整，以产生描述粪便中病原体检测与腹泻之间相关性的汇总OR。对1964份记录进行了筛选，并有130项研究（超过88 079份病例或腹泻样本和135 755份对照或非腹泻样本）可供分析。 在未调整的模型中，异源性（I2）是相当大的，在病原体之间的范围从27.6%到86.6%。在分层和校正模型中，总结OR因年龄组和环境而异，范围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）。需要将来自不同数据来源的疾病效应估计值纳入疾病病因和疾病负担模型，以产生更具代表性的估计值。世卫组织、比尔及梅林达·盖茨基金会和美国国立卫生研究院。
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 (I2) 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.