Reference no: EM133952287
Study Description
Nguyen et al., (2020), conducted a population-based case-control study based on patients that were part of the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO), the Swedish Patient Register, and Prescribed Drug Register to identify a correlation between patients diagnosed with irritable bowel disease (IBD) and the use of antibiotics a year prior to the patient being diagnosed with IBD. The researchers also included the IBD subtypes of ulcerative colitis and Crohn's disease for this research. With the use of ESPRESSO, the researchers found nearly 24,000 IBD cases through the years 2007 to 2016, in which these cases had matched controls and unaffected siblings for comparisons. The researchers utilized logistic regression to estimate multivariable-adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Get expert-level assignment help in any subject.
Strengths and Limitations
Nguyen et al.'s population-based case-control study had a primary strength in that it was a large, nationwide sample drawn from the Swedish population registries that looked at nearly 24,000 cases of IBD cases that had additional robust matching controls and full siblings. Such a large sample allows for the reduction in selection bias and accounts for shared genetic factors and environmental factors that could have contributed to the diagnosis of IBD. While the study had a strength in numbers, there were some limitations to the study that needed to be addressed. The primary limitation that has been identified is that the study's observational design limits its ability to establish causation, and there is then a potential for residual confounding, such as differences in infection severity or unmeasured lifestyle factors. Not knowing the significant medical background of each patient does not allow for a full scope analysis of the causation of IBD, which could be related to socioeconomic factors and behavioral factors that can increase the prevalence of IBD. Additionally, the prevalence of IBD in Sweden is found to be elevated with lower antibiotic dispensation patterns when compared to other countries, which can be associated with another limitation of the research.
Population, Data Sources, and Epidemiological Measures
The population that was utilized for this research included individuals who were 16 years of age or older who lived in Sweden. The patients had a compatible IBD diagnosis, including Crohn's disease and ulcerative colitis. To allow for appropriate comparison, the researchers used two sets of controls: matched population-controls that were drawn from the general population and full siblings of the IBD cases. The authors of this study utilized the Swedish registries, including pathology/histology reports, which was from the ESPRESSO, to identify valid IBD diagnoses. The authors then identified antibiotic exposure from prescription/dispensation records that were recorded through the systemic antibiotic dispensaries. The epidemiological measures incorporated into the study included the odds ratio, which compared the odds of prior antibiotic use among IBD cases versus the controls, and they also utilized a dose-response relationship to measure the cumulative antibiotic exposure. Additionally, the authors incorporated a sensitivity analysis that looked at a two-year lead-in period, which was to ignore the antibiotic dispensation in two years before the IBD diagnosis, and the researchers found that this had similar risk estimates compared to the one-year dispensation before diagnosis.
Design Appropriateness
The study design utilized by Nguyen and associates (2020) was appropriate. The case-control study design was well-suited for examining exposure and association, in which the researchers efficiently assessed antibiotic exposure using existing registry data and diagnoses of IBD.