Long–Term Health Risks after Gastroenteritis | CDC EID

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Volume 16, Number 9–September 2010
Research
Long–Term Health Risks for Children and Young Adults after Infective Gastroenteritis
Rachael E. Moorin , Jane S. Heyworth, Geoffrey M. Forbes, and Thomas V. Riley
Author affiliations: The University of Western Australia, Crawley, Western Australia, Australia (R.E. Moorin, J.S. Heyworth, T.V. Riley); and Royal Perth Hospital, Perth, Western Australia, Australia (G.M. Forbes)

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Abstract
To quantify the risk and types of sequelae attributable to prior enteric infections, we undertook a population–based retrospective cohort study using linked administrative records. The risk for first–time hospitalization for sequelae was modeled by using Cox proportional regression analysis controlling for other health and sociodemographic factors. We identified a significant increase of 64% in the rate of first–time hospitalization for sequelae for persons with prior enteric infections: 52% for intragastrointestinal sequelae and 63% for extragastrointestinal sequelae compared with first–time hospitalization for those without prior infection. Extragastrointestinal sequelae occurred predominantly during the first 5 years after first–time enteric infection. In contrast, most intragastrointestinal sequelae occurred >10 years later. Infective gastroenteritis during childhood or adolescence increases the risk for first–time hospitalization for intragastrointestinal and extragastrointestinal disease over the 2 decades after first–time enteric infection, highlighting the importance of identifying ways of reducing the incidence of such infections.
Gastroenteritis is a common illness worldwide and has a considerable effect on the public health of communities and health systems that provide care. In developing countries, gastrointestinal infection is a major cause of death, claiming ›2 million lives each year among children <5 years of age (1). By contrast, most episodes of gastroenteritis in industrialized nations do not cause serious, immediate, adverse sequelae but remain common, especially in the young (2,3). In addition to the immediate health concerns associated with gastroenteritis, subsequent medium– to long–term adverse sequelae have been described. A range of gastrointestinal, rheumatologic, neurologic, and skin and lung conditions have been associated with previous exposure to enteric infections (4–13).

Most of these data are from case reports and small–sample cross–sectional studies; however, several recent short–term longitudinal studies have provided estimates of the incidence of adverse health events after enteric infections (8,14,15). These studies suggest that the increase in risk for sequelae is considerable. For example, in a follow–up cohort study of a community exposed to a waterborne disease outbreak, the relative risks for chronic gastrointestinal symptoms, arthralgia, and psychiatric conditions were 2.4, 1.4, and 2.0, respectively (16). However, the long–term population–based extent of sequelae from prior enteric infection has remained unclear because previous studies have not adjusted for confounding variables, follow–up was short–term (8), evaluations were taken when populations were exposed to an outbreak of water–borne disease (8,14), and adverse events were either identified by self–reporting (8,14) or compared with expected, but not measured, rates of events in the general population (15).

The Western Australia Data Linkage System (WADLS) provided a unique opportunity to undertake a robust, long–term, longitudinal study of the sequelae associated with notifiable enteric infections in the general population. This system enables capture of health events in persons previously exposed and not exposed to an enteric infection. Our goal was to quantify the rate, risk, and type of sequelae attributable to previous childhood and adolescent exposure to enteric infections that lead to hospitalization, controlling for other health and sociodemographic factors.


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