Environmental pollutant exposure linked to higher IBS incidence in California residents
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Particulate matter and toxic release exposure correlated with a higher incidence of irritable bowel syndrome among a subset of California residents, according to data published in Clinical Gastroenterology and Hepatology.
“An epidemiological shift in gastrointestinal diseases is underway. The overall incidences of disorders of gut-brain interaction, inflammatory bowel disease and eosinophilic esophagitis are increasing, and there is a demographic shift in patient groups affected,” Philip N. Okafor, MD, MPH, of the department of gastroenterology and hepatology at Stanford University School of Medicine, and colleagues wrote. “While the underlying causes of this shift remain unclear, the association with industrialization suggests that environmental triggers may play a role in disease pathogenesis.”
In a retrospective ecologic study, Okafor and colleagues quantified zip code-level associations between pollution exposure and incidence of functional dyspepsia (FD), IBS, IBD and EoE using claims from the Optum Clinformatics database from 2009 to 2014 (ICD-9 era) and 2016 to 2019 (ICD-10 era). During these periods, they identified health care claims from approximately 2.9 million and 2.5 million unique patients in California, respectively, across 1,365 zip codes.
Studied pollutants included ozone, particulate matter less than 2.5 microns (PM2.5), diesel emissions, drinking water contaminants, pesticides, toxic releases from industrial facilities and traffic density.
According to analysis, the estimated incidence of FD during the ICD-9 era was 0.65 per 100 person-years (0.29/100 person-years during ICD-10 era). During that time, the estimated incidence of IBS was 0.56 per 100 person years, while the incidence of IBD and EoE ranged from 0.02 to 0.16 per 100 person-years.
Increasing PM2.5 and airborne toxic releases correlated with an increased incidence of IBS during both eras, with adjusted incidence rate ratios reported around 1.03 for both pollutants, suggesting that an increase of either “1 µg/m3 of PM2.5 or of 1% in airborne toxic releases will lead to a roughly 3% increase in IBS incidence.”
Drinking water contaminants (aIRR = 1.061; 95% CI, 1.023-1.101) and traffic density (aIRR = 1.019; 95% CI, 1.009-1.03) also associated with the incidence of IBS in the ICD-9 era, with similar reports in the ICD-10 era.
“Our study is the largest to date that systematically explores the relationship between environmental pollutant exposures and GI disease incidence on a population scale,” Okafor and colleagues concluded. “We find evidence of an association between PM2.5 and airborne toxic releases from industrial facilities and IBS, warranting further confirmatory epidemiologic and mechanistic studies to evaluate the role of these exposures in IBS development.”
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