Abstract
BackgroundBowel disorders have destructive impacts on the patients social and mental aspects of life and can cause emotional distress. The risk of developing bowel incontinence also increases with age. The rate of incidence of inflammatory bowel disease in Manitoba, Canada, has been unusually raised. Therefore, it is important to identify trends in the incidence of bowel disorders that may suggest further epidemiological studies to identify risk factors and identify any changes in important factors.MethodsAn important part of spatial epidemiology is cluster detection as it has the potential to identify possible risk factors associated with disease, which in turn may lead to further investigations into the nature of diseases. To test for potential disease clusters many methods have been proposed. The focused detection methods including the circular spatial scan statistic (CSS), flexible spatial scan statistic (FSS), and Bayesian disease mapping (BYM) are among the most popular disease detection procedures. A frequentist approach based on maximum likelihood estimation (MLE) has been recently used to identify potential focused clusters as well. The aforementioned approaches are studied by analyzing a dataset of bowel disorders in the province of Manitoba, Canada, from 2001 to 2010.ResultsThe CSS method identified less regions than the FSS method in the south part of the province as potential clusters. The same regions were identified by the BYM and MLE methods as being potential clusters of bowel disorders with a slightly different order of significance. Most of these regions were also detected by the CSS or FSS methods.ConclusionsOverall, we recommend using the methods BYM and MLE for cluster detection with the similar population and structure of regions as in Manitoba. The potential clusters of bowel disorders are generally located in the southern part of the province including the eastern part of the city of Winnipeg. These results may represent real increases in bowel disorders or they may be an indication of other covariates that were not adjusted for in the model used here. Further investigation is needed to examine these findings, and also to explore the cause of these increases.
Highlights
Bowel disorders have destructive impacts on the patients social and mental aspects of life and can cause emotional distress
Since the bowel disorder data used in the study came from a survey, appropriate weights established by Statistics Canada [27] were applied to the data, which was aggregated over the study period from 2001 to 2010
For the Bayesian disease mapping (BYM) and maximum likelihood estimation (MLE) approaches, each region is ranked under three criteria according to the lower limit of the credible/ prediction interval
Summary
Bowel disorders have destructive impacts on the patients social and mental aspects of life and can cause emotional distress. It is important to identify trends in the incidence of bowel disorders that may suggest further epidemiological studies to identify risk factors and identify any changes in important factors. Inflammatory bowel disease (IBD) includes Crohn’s disease and ulcerative colitis and is distinguished by the presence of chronic immunoinflammatory lesions in the large intestine wall (ulcerative colitis) or anywhere in the gastrointestinal tract (Crohn’s disease) [1]. These diseases are often diagnosed in early adulthood and are characterized by a relapsing and remitting course. The symptoms of IBS are abdominal pain or discomfort with a change in bowel function. The treatment is aimed at reducing the symptoms of IBS and may be treated by dietary and lifestyle changes recommended by a doctor, pharmacotherapy, and psychosocial interventions [6,7]
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