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American Journal of Epidemiology Advance Access originally published online on August 18, 2006
American Journal of Epidemiology 2006 164(7):615-623; doi:10.1093/aje/kwj260
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

A Population-based Ecologic Study of Inflammatory Bowel Disease: Searching for Etiologic Clues

Chris Green1,2, Lawrence Elliott2, Carole Beaudoin1,2 and Charles N. Bernstein3,4

1 Public Health Branch, Manitoba Health, Winnipeg, Manitoba, Canada
2 Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
3 Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
4 Inflammatory Bowel Disease Clinical and Research Centre, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

Correspondence to Dr. Charles N. Bernstein, Faculty of Medicine, University of Manitoba, 804F-715 McDermot Avenue, Winnipeg, Manitoba, Canada R3E-3P4 (e-mail: cbernst{at}cc.umanitoba.ca).

The authors' objective in this study was to determine geographic variations in the incidence of inflammatory bowel disease (IBD), specifically Crohn's disease and ulcerative colitis, in the Canadian province of Manitoba and its association with the sociodemographic, geographic, and disease-related characteristics of the study population. Using the University of Manitoba IBD Epidemiology Database, the authors applied spatial and ecologic techniques to visualize, explore, and model the incidence of Crohn's disease and ulcerative colitis for the period 1990–2001. The study demonstrated marked, statistically significant geographic variability in rates of both Crohn's disease and ulcerative colitis associated with the characteristics of the study population. Incidences of Crohn's disease and ulcerative colitis were observed to be highest among non-Aboriginal persons, persons of high socioeconomic status, persons with the lowest rates of enteric infection, and persons with the highest rates of multiple sclerosis. The observation of an inverse association between IBD incidence and rates of reportable enteric infection at the population level is consistent with the "hygiene hypothesis," which suggests that early exposure to enteric agents affords protection against eventual development of IBD. The positive association between IBD incidence rates and multiple sclerosis suggests that these two chronic, immunologically mediated diseases may have a common environmental etiology. This study underscores the importance of environment in IBD causation.

colitis, ulcerative; Crohn's disease; inflammatory bowel disease; multiple sclerosis

Abbreviations: CI, confidence interval; IBD, inflammatory bowel disease; IRR, incidence rate ratio

Editor's note: An invited commentary on this article appears on page 624, and the authors' response appears on page 627.


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