METHODS: This two-stage study included 365,206 Canadians from the Quebec Birth Cohort on Immunity and Health (1970-2014; stage 1). Vaccination status was registry-based and inflammatory bowel disease cases were identified from health services with validated algorithms. We documented additional factors among 2644 participants in a nested case-control study in 2021 (stage 2). A two-stage logistic regression analysis was applied to estimate the odds ratios (OR), corrected for sampling fractions and adjusted for confounding factors. We used interaction terms to assess sex-differences on the multiplicative scale.
RESULTS: In the stage 1 sample, 2419 cases of Crohn\'s disease and 1079 of ulcerative colitis were included. Forty-six percent of non-cases received the BCG vaccine as compared to 47% for Crohn\'s disease and 49% for ulcerative colitis. Associations differed by sex. BCG vaccination was not associated with Crohn\'s disease among men (OR = 0.91; 95% CI: 0.79-1.04) but was related to an increased risk among women (OR = 1.13; 95% CI: 1.00-1.28, P interaction: 0.001). For ulcerative colitis, there was a tendency toward a slightly elevated risk among men (OR = 1.09; 95%CI: 0.90-1.32), whereas the risk was more substantial for women (OR = 1.17; 95% CI:0.99-1.39, P interaction: <0.001).
CONCLUSIONS: BCG vaccination does not play a preventive role in inflammatory bowel disease. Our results point to distinct associations between men and women.
方法:这项两阶段研究包括来自魁北克出生队列免疫和健康(1970-2014年;阶段1)的365,206名加拿大人。疫苗接种状态是基于注册的,并且使用经过验证的算法从卫生服务中识别出炎症性肠病病例。我们在一项巢式病例对照研究中记录了2644名参与者的其他因素,2021年(第二阶段)。采用两阶段逻辑回归分析估计比值比(OR),针对采样分数进行校正,并针对混杂因素进行调整。我们使用交互术语在乘法量表上评估性别差异。
结果:在第1阶段样本中,纳入2419例克罗恩病和1079例溃疡性结肠炎。46%的非病例接种了卡介苗,而克罗恩病的比例为47%,溃疡性结肠炎的比例为49%。协会因性别而异。卡介苗接种与男性克罗恩病无关(OR=0.91;95%CI:0.79-1.04),但与女性风险增加有关(OR=1.13;95%CI:1.00-1.28,P交互作用:0.001)。对于溃疡性结肠炎,男性风险有轻微升高的趋势(OR=1.09;95CI:0.90-1.32),而女性的风险更大(OR=1.17;95%CI:0.99-1.39,P交互作用:<0.001)。
结论:卡介苗接种对炎症性肠病没有预防作用。我们的结果指出了男女之间的明显关联。