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Rural environment lowers rates of IBD in Canada

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WASHINGTON — Exposure to a rural environment at a young age was associated with lower risk of inflammatory bowel disease, according to data presented at Digestive Disease Week 2015.

“Rural household at diagnosis is associated with lower risk of IBD in Canada. This association is strongest in children,” Eric I. Benchimol, MD, assistant professor at the University of Ottawa, said during his presentation. “In our birth cohort, early life exposure to the rural environment is protective.”

Eric I. Benchimol

Using health administrative data from three Canadian provinces — Ontario, Manitoba and Alberta — Benchimol and colleagues examined 52% of the Canadian population. After identifying IBD patients with validated algorithms, the researchers found approximately 45,000 incident cases of IBD from 1999 to 2010.

In a birth cohort of children born after 1991, they looked to determine risk of developing IBD by 2010 and the risk associated with rural or urban exposure in the first 5 years of life. They used 14 definitions of rurality, ranging from population density to modified Beale codes, but for this study focused on the Metropolitan Area and Census Agglomeration Influenced Zones (MIZ) definition.

Benchimol showed that all provinces had an increased incidence of IBD when they lived in an urban environment:

• Ontario: 25.5 cases per 100,000 person years (95% CI, 24.7-26.3) in rural areas; 26.0 per 100,000 person years (95% CI, 25.7-26.3) in urban;
• Manitoba: 19.7 per 100,000 (95% CI, 18.4-21.1) vs. 24.5 per 100,000 (95% CI, 23.5-25.5), respectively;
• Alberta: 22.3 per 100,000 (95% CI, 21.2-23.5) vs. 36.1 per 100,000 (95% CI, 35.3-37), respectively.

This increased risk was particularly prominent in children and moreso if they spent the first 5 years of life in an urban household. Benchimol suggested this could be due to early life changes to at-risk populations, microbiome or gene-environment interactions.

For more information:

Benchimol EI, et al. Abstract 6. Presented at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.

Disclosure: Benchimol reports no relevant financial disclosures Please see the DDW faculty disclosure index for all other researchers’ relevant financial disclosures.

Editor's note: This article was updated on June 15, 2015, with clarifications from the presenter.