Geographic distribution and ecological studies of inflammatory bowel disease in southeastern Norway in 1990-1993

Background: The purpose was to study the spatial distribution of cases of inflammatory bowel disease (IBD) and characterize municipalities with high incidences in a search for environmental risk factors. Methods: Spatial clustering of patients diagnosed with IBD during 1990-1993 were studied in 4 counties in southeastern Norway, and an ecological analysis was conducted to study the relationship between risk of IBD in the municipalities and their characteristics such as population, health care, urban/rural change, and socioeconomic change. Results: One cluster consisting of 4 municipalities was identified for IBD in empty setstfold county (P = 0.011). The ecological analysis showed that the incidence rate of IBD was 33% (95% confidence interval [CI]: 2%-75%) higher in municipalities with the highest level of education compared to the lowest level of education and 35% (2%-78%) higher in urban than rural municipalities. The incidence rate was 11% (1%-20%) lower in municipalities with a high urban/rural change compared to municipalities with low urban/ rural change. Individuals living in high-risk municipalities were 3 times (1.57-5.45) more likely to have a first-degree family member with IBD than individuals living in normal-risk municipalities. Conclusions: The geographic distribution of cases with IBD is not uniformly distributed and is related to urbanization, level of education, and moving pattern. Geographic distribution may be explained by either changes in environment-host relationships or neurobiological mechanisms due to stress and economic frustration. These factors and genetic predisposition might also explain increased familial clustering. Spatial clustering was significant neither for Crohn's disease CD nor ulcerative colitis (UC) but showed a stronger tendency within the CD group.