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Serious Infections in Pediatric Inflammatory Bowel Disease 2002-2017: A Nationwide Cohort Study
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Columbia University, New York NY, USA.ORCID iD: 0000-0003-1024-5602
Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Unit of Pediatric Gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0003-1465-0963
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2021 (English)In: The Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 238, p. 66-73e1Article in journal (Refereed) Published
Abstract [en]

Objective: To assess absolute and relative risks of serious infections (resulting in inpatient care) in children with inflammatory bowel disease (IBD) compared with the general population.

Study design: We identified children (<18 years of age) with a first diagnosis of IBD in the Swedish nationwide health registry (2002-2017; n = 5767) and individuals from the general population matched for sex, age, calendar year, and place of residence (reference group; n = 58 418). Hazard ratios (HRs) for serious infections were estimated using Cox regression separately in children with ulcerative colitis (n = 2287), Crohn's disease (n = 2365), and IBD unclassified (n = 1115).

Results: During 17 408 person-years of follow-up, 672 serious infections (38.6/1000 person-years) occurred among the children with IBD compared with 778 serious infections in the reference group (4.0/1000 person-years; adjusted HR (95% CI), 9.46 [8.53-10.5]). HRs were increased for children with ulcerative colitis 8.48 (7.21-9.98), Crohn's disease 9.30 (7.86-11.0), and IBD unclassified 12.1 (9.66-16.1). HRs were highest in the first year of follow-up (HR = 12.6 [10.7-14.9]), then decreasing to a 4.8-fold increased risk beyond 10 years of follow-up. Particularly high HRs were also seen in children with IBD undergoing surgery. Apart from a high relative risk of gastrointestinal infections resulting in hospitalization, children with IBD were also at an increased risk of opportunistic infections (HR = 11.8 [6.17-22.5]).

Conclusions: Children with IBD have an increased risk of serious infection requiring hospitalization compared with the general population.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 238, p. 66-73e1
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:oru:diva-95837DOI: 10.1016/j.jpeds.2021.06.076ISI: 000719233600013PubMedID: 34216628Scopus ID: 2-s2.0-85114751623OAI: oai:DiVA.org:oru-95837DiVA, id: diva2:1618397
Funder
Swedish Society of MedicineThe Karolinska Institutet's Research FoundationPfizer AB
Note

Funding agencies:

Strategic Research Area Epidemiology program at Karolinska Institutet

Regional Agreement on Medical Training and Clinical Research between Stockholm County Council

Mag-tarmfonden

Bengt Ihre foundation

Janssen Corporation

Johnson & Johnson USA

Janssen Biotech Inc

Ferring Pharmaceuticals

Available from: 2021-12-09 Created: 2021-12-09 Last updated: 2023-12-08Bibliographically approved

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Ludvigsson, Jonas F.

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