Crohn’s disease, which affects the large and small intestines, is even more common in Canada and affects about 234 per 100,000 people, with an incidence of 13.4 per 100,000 each year. By comparison, ulcerative colitis prevalence is 58 to 157 per 100,000 in Northern Europe and about 167 per 100,000 for an area of Minnesota. Crohn’s disease prevalence ranges from 27 to 48 per 100,000 in Northern Europe to 144 per 100,000 in an area of Minnesota. Some Third World nations and areas in tropical latitudes have still lower rates. Although the reasons for these differences remain unclear, the hygiene hypothesis may help explain the distribution in Canada, said Richard Fedorak, M.D., of the University of Alberta in Edmonton, a co-author. “If you live in an environment that’s too clean or too sterile as a child your intestines are not exposed to bacteria of the same types and numbers you would be exposed to in a tropical area,” he said. which is especially true for Canada because much of the country has cold winters with little bacterial activity in the soil. Then if the genetic triggers are present, “your intestine is not able to tolerate bacteria as you get older and starts to destroy itself,” he added. Supporting this speculation, the researchers discovered differences among provinces: Nova Scotia in the Maritimes consistently had the highest rates of ulcerative colitis (19.2 incidence and 247.9 prevalence per 100,000) and Crohn’s disease (20.2 incidence and 318.5 per 100,000), Following closely is Alberta, with ulcerative colitis incidence of 11.0 and prevalence of 185.0 per 100,000 and Crohn’s disease incidence of 16.5 and prevalence of 283.0 per 100,000, and Manitoba had likewise high rates of ulcerative colitis (15.4 incidence and 248.6 prevalence per 100,000) and Crohn’s disease (15.4 incidence and 271.4 prevalence per 100,000); Whereas British Columbia, on the west coast, consistently had much lower rates of both ulcerative colitis (9.9 incidence and 162.1 prevalence per 100,000) and Crohn’s disease (8.8 incidence and 160.7 prevalence per 100,000). British Columbia proved to be an outlier, particularly for Crohn’s disease perhaps because of its milder winters, more precipitation, and “because its population ethnic make-up is somewhat different from the rest of Canada,” the researchers wrote. Much of British Columbia’s immigration in the past 20 years has been from Asia, they said. “Asians are known to have less [inflammatory bowel disease] than Caucasians,” perhaps because of genetics, less sterile conditions during childhood, or other environmental factors. Males and females generally had similar rates of ulcerative colitis though significantly more females had Crohn’s disease (1.31 ratio, 95% CI 1.23-1.40). Notably, though, the prevalence of Crohn’s disease was significantly greater in boys than girls (prevalence 49.6 versus 43.8 per 100,000, P=0.0001). After adjusting for age, gender, and province, the prevalence of ulcerative colitis and Crohn’s disease was slightly more common in urban areas (urban-to-rural ratio 1.13 (P=0.01) and 1.05 (P-value not significant), respectively). The researchers used government health system databases from five of the 10 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba, and Nova Scotia) to determine the number of individuals who received health care, whether hospital- or outpatient clinic-based, for either type of inflammatory bowel disease.
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Endoscopist specialty is associated with colonoscopy quality
The final sample for Calgary included 37 endoscopists and 538 patients. The average number of patients per endoscopist was 15, and ranged from 1 to 73 among gastroenterologists, and from 6 to 30 among surgeons. Table 1 presents characteristics of patients from Montreal and Calgary. Table 1. Patient characteristics by city Results of hierarchical logistic regression The hierarchical logistic regression results with polypectomy as the outcome for Montreal and Calgary are shown in Table 2 . The odds ratios for polypectomy with surgeons as compared to gastroenterologists, adjusted for patient age, sex, family history of CRC, indication (screening vs. non-screening), and previous colonoscopy were 0.48 (95% CrI: 0.320.71) in Montreal and 0.73 (95% CrI: 0.431.21) in Calgary. Table 2. Odds ratio estimates for polypectomy from hierarchical logistic regression models for Montreal and Calgary To illustrate variability of polypectomy rates, endoscopist-specific polypectomy rate estimates from hierarchical logistic regression for each specialty are shown in Figure 1 . The estimates ranged from 6.0% (95% CrI: 0.3019.6%) to 28.6% (95% CrI: 15.646.2%) among surgeons and from 12.3% (95% CrI: 3.925.9%) to 62.1% (95% CrI: 45.678.9%) among gastroenterologists. Figure 1. Histograms of endoscopist-specific polypectomy rates estimated from hierarchical logistic regression models among A) gastroenterologists and B) surgeons.
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