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American Journal of Epidemiology Advance Access published online on August 18, 2006
American Journal of Epidemiology, 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.
Received April 14, 2005
Accepted August 9, 2005

ORIGINAL CONTRIBUTIONS

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

Chris Green 1, Lawrence Elliott 2, Carole Beaudoin 1, and Charles N. Bernstein 3 *

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

* To whom correspondence should be addressed.
Charles N. Bernstein, E-mail: cbernst{at}cc.umanitoba.ca


  Abstract

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.

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