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© 1998 Oxford University Press
research-article |
Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study
aDepartment of Statistics, Chair of Medical Statistics and Epidemiology, University of Milan Milan, Italy
bDivision of internal Medidne, Bellaria Hospital, University of Bologna Bologna, Italy
cDepartment of Internal Medicine and Public Health, Gastroenterology Unit, Universiy of L'Aquila L'Aquilan Italy
dGastroenterology Unit, Careggi Hospital Florence, Italy
eGastroenterology Unit, San Filippo Neri Hospital Rome, Italy
fGastroenterology Unit, Nuovo Regina Margherita Hospital Rome, Italy
gMedical Clinic II, Gastroenterology Unit, University La Sapienza Rome, Italy
hGastroenterology Unit, 2nd University of Naples Naples, Italy
iGastroenterology Unit, University of Modena Modena, Italy
jInternal Medicine, University of Messma Messina, Italy
kGastroenterlogy Unit, University of Genoa Genoa, Italy
lGastroenterology Unit, University of Bari Bari, Italy
mDivision of Gastroenterology, GB Morgagni Hospital Forli, Italy
nCooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC): Torchio P (Milan), Migilo F, Elmi G, venerato S (Bologna); Taddel G, Viscido A (L'Aqulla); D'Albasio G. Paladini I. Surrenti C (Florence); Capurso G, Paoluzi p, Spimpolo N, Gioleni A (Rome): Savastano A, (Naples); Mastronardi M (Modena): Francavilia A (Bari: Vincenzi M (Forli)
Reprint requests to: Prof. Giovanni Corrao, Department of Statistics. Universltą di Milano, Viale Sarca, 202, 20126 Milano, Italy
BACKGROUND: Using data from a case-control study carried out in Italy 1989–1992, we estimated the odds ratios (OR) and the population attributable risks (AR) for inflammatory bowel diseases (IED) in relation to smoking, oral contraception and breastfeeding in infancy.
METHODS: The study focused on 819 cases of IBD (594 ulcerative colitis: UC; 225 Crohn's disease: CD) originating from populations resident in 10 Italian areas, and age-sex matched paired controls.
RESULTS: Compared with non-smokers, former smokers were at increased risk of UC (OR = 3.0; 95% confidence interval [CI] : 2.1–4.3), whereas current smokers were at increased risk of CD (OR = 1.7; 95% CI: 1.1%2.6). Females who reported use of oral contraceptives for at least one month before onset of symptoms had a higher risk of CD (OR % 3.4; 95% CI: 1.0–11.9), whereas no significant risk was observed for UC. Lack of breastfeeding was associated with an increased risk of UC (OR = 1.5; 95% CI: 1.1–2.1) and CD (OR = 1.9; 95% CI: 1.1–3.3). Being a ‘former smoker’ was the factor with the highest attributable risk of UC both in males (AR = 28%; 95% CI: 20–35 %) and in females (AR = 12%; 95% CI: 5–18%). Smoking was the factor with the highest attributable risk for CD in males (AR = 31%; 95% CI: 11–50%). Lack of breastfeeding accounted for the highest proportion of CD in females (AR 11%; 95% CI: 1–22%). Oral contraceptive use accounted for 7% of cases of UC and for 11% of cases of CD.
CONCLUSIONS: Taken together, the considered factors were responsible for a proportion of IBD ranging from 26% (CD females) to 36% (CD males). It is concluded that other environmental and genetic factors may be involved in the aetiology of IBD.
Keywords Attributable risk, ulcerative colitis, oral contraceptives, Crohn's disease, regression models, smoking, breastfeeding
Accepted 14 July 1997
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