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Microscopic Colitis in Denmark: Regional Variations in Risk Factors and Frequency of Endoscopic Procedures
Petra Weimers1, Dorit Vedel Ankersen1, Søren N Lophaven2
1Department of Gastroenterology, North Zealand University Hospital, Capital Region, Denmark.
Objective:
Microscopic colitis [MC], encompassing collagenous colitis [CC] and lymphocytic colitis [LC], is an increasingly prevalent gastrointestinal disease with an unknown aetiology. Previous research has reported significant differences in the incidence of MC within Denmark, with the lowest incidence found in the most populated region [Capital Region of Denmark]. Our aim was to elucidate the causes of these regional differences.
Design:
All incident MC patients [n = 14 302] with a recorded diagnosis of CC [n = 8437] or LC [n = 5865] entered in The Danish Pathology Register between 2001 and 2016 were matched to 10 reference individuals [n = 142 481]. Information regarding drug exposure, including proton pump inhibitors [PPIs], selective serotonin reuptake inhibitors [SSRIs], statins, and nonsteroidal anti-inflammatory drugs [NSAIDs], were retrieved from The Danish National Prescription Registry. Information regarding endoscopy rate, smoking-related diseases, and immune-mediated inflammatory diseases were acquired from The Danish National Patient Registry.
Results:
Smoking, immune-mediated inflammatory diseases, exposure to PPIs, SSRIs, statins, and NSAIDs were significantly associated with MC in all Danish regions. The association between drug exposure and MC was weakest in the Capital Region of Denmark with an odds ratio of 1.8 (95% confidence interval [CI]: 1.61-2.01). The relative risk of undergoing a colonoscopy with biopsy was significantly increased in sex- and age-matched controls in all regions compared with controls from the Capital Region of Denmark, with the greatest risk found in the Region of Southern Denmark, 1.37 [95% CI: 1.26-1.50].
Conclusions:
The cause of the regional differences in MC incidence in Denmark seems to be multifactorial, including variations in disease awareness and distribution of risk factors.
Insights
Regional differences in microscopic colitis (MC) incidence in Denmark are multifactorial. Factors include variations in disease awareness and risk factor distribution, impacting diagnosis rates across regions.
Area of Science:
- Gastroenterology
- Epidemiology
- Pharmacology
Background:
- Microscopic colitis (MC), comprising collagenous colitis (CC) and lymphocytic colitis (LC), is a gastrointestinal condition with increasing prevalence and unknown etiology.
- Previous studies indicate significant regional variations in MC incidence within Denmark, with the Capital Region exhibiting the lowest rates.
Purpose of the Study:
- To investigate the underlying causes for observed regional disparities in microscopic colitis incidence across Denmark.
- To identify factors contributing to the lower incidence of MC in the Capital Region of Denmark.
Main Methods:
- A nationwide cohort study involving 14,302 incident MC patients (8,437 CC, 5,865 LC) diagnosed between 2001 and 2016.
- Data on drug exposure (PPIs, SSRIs, statins, NSAIDs), smoking, immune-mediated inflammatory diseases, and endoscopy rates were extracted from Danish national registries.
- Patients were matched with 142,481 reference individuals for comparison.
Main Results:
- Smoking, immune-mediated inflammatory diseases, and exposure to PPIs, SSRIs, statins, and NSAIDs were significantly associated with MC across all Danish regions.
- The association between drug exposure and MC was weakest in the Capital Region (OR 1.8, 95% CI: 1.61-2.01).
- Increased colonoscopy with biopsy rates were observed in all regions compared to the Capital Region, with the highest risk in the Region of Southern Denmark (RR 1.37, 95% CI: 1.26-1.50).
Conclusions:
- Regional variations in microscopic colitis incidence in Denmark are attributed to multiple factors.
- Differences in disease awareness and the distribution of risk factors, including medication use and diagnostic practices, likely contribute to these observed geographical disparities.
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