Abstract
studies with limited follow-up. To guide future research, we sought to further evaluate the association between a number of potential risk factors during the first year of life and subsequent CD by performing a nationwide birth cohort study in Denmark. Methods: All children born in Denmark between 1995 and 2009 were identified in the Danish Medical Birth Registry and followed until death, emigration, or end of study (January 1, 2013). Cases of CD were identified using the Danish National Patient Registry (DNPR), using a validated case-finding algorithm (PPV > 90%). Multivariate cox proportional hazards models were used to identify potential risk factors associated with the development of CD. Candidate risk factors were selected a. priori and ascertained through the DNPR or the nationwide prescription database. Results: The birth cohort consisted of 979,039 children followed for a mean of 9.5 years (9,262,962 person-years of follow up). The characteristics of these children are displayed in the table. A total of 208 cases of CD were observed during followup. As expected, there was a strong association with family history of CD (HR 14.0, 95% CI 6.9,28.3) (Table). The multivariate analysis further identified urban life (HR= 1.4, 95% CI 1.0-1.8), caesarean section (HR=1.3, 95%CI 0.9-1.8), and early life antibiotic use/infections requiring hospitalization (HR=1.4, 95% CI 1.0-1.8) as potential risk factors for CD. We found no independent associations for the following factors: gender, birth order, gestational age, maternal smoking during pregnancy, birth year, and NSAID use during first year of life (Table). Discussion: In addition to the well-known association between family predisposition and risk of CD, our exploratory analysis identified factors related with changes in the host microbiome as potential risk factors for CD. These findings support the hygiene hypothesis. Table
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