Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 16, Number 9—September 2010
Research

Long-Term Health Risks for Children and Young Adults after Infective Gastroenteritis

Rachael E. MoorinComments to Author , Jane S. Heyworth, Geoffrey M. Forbes, and Thomas V. Riley
Author affiliations: Author affiliations: The University of Western Australia, Crawley, Western Australia, Australia (R.E. Moorin, J.S. Heyworth, T.V. Riley); Royal Perth Hospital, Perth, Western Australia, Australia (G.M. Forbes)

Main Article

Table 3

Number and rate of first-time hospitalizations, rate ratios, and attributable risk for sequelae for those with and without history of enteric infection, Western Australia, Australia, January 1,1985–December 31, 2000*

Type of sequelae First-time hospitalizations
Crude rate ratio, RR (95% CI) Adjusted† rate ratio, RR (95% CI) Adjusted
AR, %‡ Goodness of fit§
With history
No history
No. Rate No. Rate
Any 5,634 27.8 41,054 11.8 2.36 (2.28–2.41) 1.64 (1.59–1.67) 39 0.05
Intragastrointestinal 1,267 4.0 9,385 2.3 1.77 (1.67–1.88) 1.52 (1.42–1.62) 34 0.04
Extragastrointestinal 5,045 24.1 34,425 9.8 2.46 (2.39–2.54) 1.63 (1.57–1.68) 39 0.08

*Rates are per 100,000 person-years. RR, relative risk; CI, confidence interval; AR, attributable risk.
†Multivariate Cox regression estimating the adjusted rate ratio of first-time hospitalization for any, intragastrointestinal, and extragastrointestinal sequelae. Adjusted for gender, indigenous status, year of birth, age at exposure or proxy, singleton, weight at birth, hospital birth, mother’s region of birth, father’s region of birth, socioeconomic status, accessibility to services and previous hospitalization for comorbidity.
‡Proportion of first-time hospitalizations for sequelae where previous exposure to an enteric infection was a component cause.
§Pseudo R2. As explained by Hosmer and Lemeshow (20), a measure analogous to R2 would be useful as a measure of Cox regression model performance; however, although a pseudo R2 can be calculated the values obtained are often low because of the censored nature of the data even though the model is adequate. In our models the R2 values were 0.05, 0.04 and 0.08 for the 3 models (any, intragastrointestinal, and extragastrointestinal), respectively. The models generated were population-based descriptive models, which aimed to evaluate the average effect on survival to first-time hospitalization with the outcome of interest adjusted for known and measurable confounders, rather than predict the probability of survival for a specified individual. Thus, the most important assessment criteria for evaluating the appropriateness of a descriptive Cox regression model is that the proportional hazards assumption is not violated and the overall model is significant. In all of our models the proportional hazards assumption was tested and found not to be violated and the overall model significance was Prob > χ2 <0.00005.

Main Article

References
  1. Harlem  G. WHO report on infectious diseases: removing the obstacle to healthy development. Brunotland (Switzerland): World Health Organization; 1999.
  2. Hall  GV, Kirk  MD, Ashbolt  R, Stafford  R, Lalor  K. Frequency of infectious gastrointestinal illness in Australia, 2002: regional, seasonal and demographic variation. Epidemiol Infect. 2006;134:1118. DOIPubMedGoogle Scholar
  3. Heyworth  JS, Glonek  G, Maynard  EJ, Baghurst  PA, Finlay-Jones  J. Consumption of untreated tank rainwater and gastroenteritis among young children in South Australia. Int J Epidemiol. 2006;35:10518. DOIPubMedGoogle Scholar
  4. Lindsay  JA. Chronic sequelae of foodborne disease. Emerg Infect Dis. 1997;3:44352. DOIPubMedGoogle Scholar
  5. Crushell  E, Harty  S, Sharif  F, Bourke  B. Enteric Campylobacter: purging its secrets? Pediatr Res. 2004;55:312. DOIPubMedGoogle Scholar
  6. Allos  BM, Blaser  MJ. Campylobacter jejuni and the expanding spectrum of related infections. Clin Infect Dis. 1995;20:1092101. DOIPubMedGoogle Scholar
  7. Doman  DB. Campylobacter jejuni relapsing colitis. Dig Dis Sci. 1982;27:956. DOIPubMedGoogle Scholar
  8. Ternhag  A, Torner  A, Svensson  A, Ekdahl  K, Giesecke  J. Short- and long-term effects of bacterial gastrointestinal infections. Emerg Infect Dis. 2008;14:1438. DOIPubMedGoogle Scholar
  9. Baert  D, De Man  M, Oosterbosch  L, Duyck  MC, Van Der Spek  P, Lepoutre  L. Infectious gastroenteritis: are they all the same? Acta Clin Belg. 1995;50:26973. PubMedGoogle Scholar
  10. Bunning  VK, Lindsay  JA, Archer  DL. Chronic health effects of foodborne microbial disease. World Health Stat Q. 1997;50:516. PubMedGoogle Scholar
  11. Goudswaaed  J, Sabbe  L, Te Winkel  W. Reactive arthritis as a complication of Campylobacter lari enteritis. J Infect. 1995;31:1716. DOIPubMedGoogle Scholar
  12. Hahn  AF. Guillain-Barré syndrome. Lancet. 1998;352:63541. DOIPubMedGoogle Scholar
  13. Rees  JH, Soudain  SE, Gregson  NE. Campylobacter jejuni infection and Guillain-Barré syndrome. N Engl J Med. 1995;333:13749. DOIPubMedGoogle Scholar
  14. Marshall  JK, Thabane  M, Garg  AX, Clark  WF, Salvadori  M, Collins  SN. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology. 2006;131:44550. DOIPubMedGoogle Scholar
  15. Garg  AX, Pope  JE, Thiessen-Philbrook  H, Clarke  WF, Ouimet  J. Arthritis risk after acute bacterial gastroenteritis. Rheumatology (Oxford). 2008;47:2004. DOIPubMedGoogle Scholar
  16. Garg  AX, Marshall  J, Salvadori  M, Thiessen-Philbrook  HR, Macnab  J, Suri  RS, A gradient of acute gastroenteritis was characterized, to assess risk for long-term health sequelae after drinking bacterial-contaminated water. J Clin Epidemiol. 2006;59:4218. DOIPubMedGoogle Scholar
  17. Australian Bureau of Statistics. Information paper, census of population and housing, socio-economic indexes for areas 2001. Canberra (Australia): The Bureau; 2003.
  18. Commonwealth Department of Health and Aged Care. Measuring remoteness: accessibility/remoteness index of Australia (ARIA) occasional papers: mew series number 14. Canberra (Australia): The Department; 2001.
  19. Holman  CDJ, Preen  DB, Baynham  NJ, Finn  JC, Semmens  JB. A multipurpose Australian comorbidity scoring system performed better than the Charlson index. J Clin Epidemiol. 2005;58:100614. DOIPubMedGoogle Scholar
  20. Hosmer  D, Lemeshow  S. Survival analysis: regression modelling of time to event data. New York: John Wiley and Sons; 1999.
  21. Porter  C, Tribble  D, Aliaga  P, Halvorson  H, Riddle  M. Infectious gastroenteritis and risk of developing inflammatory bowel disease. Gastroenterology. 2008;135:7816. DOIPubMedGoogle Scholar
  22. Kvien  TK, Glennas  A, Melby  K, Gransfors  K, Andrup  O. Reactive arthritis: incidence, triggering agents and clinical presentation. J Rheumatol. 1994;21:11522. PubMedGoogle Scholar
  23. Kaldor  J, Speed  JR. Guillain-Barré syndrome and Campylobacter jejuni: a serological study. Br Med J (Clin Res Ed). 1984;288:186770. DOIPubMedGoogle Scholar
  24. Mishu Allos  B. Association between Campylobacter infection and Guillain-Barré syndrome. J Infect Dis. 1997;176(Suppl 2):S1258. DOIPubMedGoogle Scholar
  25. Nachamkin  I. Chronic effects of Campylobacter infection. Microbes Infect. 2002;4:399403. DOIPubMedGoogle Scholar
  26. Neuwirth  C, Francois  C, Laurent  N, Pechinot  A. Myocarditis due to Salmonella virchow and sudden infant death. Lancet North Am Ed. 1999;354:1004.
  27. Holman  C. Western Australia: development of a health services research linked database. Aust N Z J Public Health. 1999;23:4539. DOIPubMedGoogle Scholar
  28. Hall  G, Yohannes  K, Raupach  J, Becker  N, Kirk  M. Estimating community incidence of Salmonella, Campylobacter, and Shiga toxin–producing Escherica coli infections, Australia. Emerg Infect Dis. 2008;14:16019. PubMedGoogle Scholar
  29. Thomas  MK, Majowicz  SE, Pollari  F, Sockett  PN. Burden of acute gastrointestinal illness in Canada, 1999–2007: interim summary of NSAGI activities. Can Commun Dis Rep. 2008;34:815. PubMedGoogle Scholar

Main Article

Page created: August 28, 2011
Page updated: August 28, 2011
Page reviewed: August 28, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external