Copyright
©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk factors of admission for acute colonic diverticulitis in a population-based cohort study: The North Trondelag Health Study, Norway
Aras Jamal Talabani, Stian Lydersen, Eivind Ness-Jensen, Birger Henning Endreseth, Tom-Harald Edna
Aras Jamal Talabani, Tom-Harald Edna, Department of Surgery, Levanger Hospital, North Trondelag Hospital Trust, 7600 Levanger, Norway
Stian Lydersen, Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
Eivind Ness-Jensen, HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Levanger, Norway
Eivind Ness-Jensen, Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, SE - 171 76 Stockholm, Sweden
Eivind Ness-Jensen, Clinic of Medicine, St. Olav’s Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
Birger Henning Endreseth, Clinic of Surgery, St. Olav’s Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
Birger Henning Endreseth, Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
Tom-Harald Edna, Unit for Applied Clinical Research, Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
Author contributions: Jamal Talabani A contributed to conception of the study, interpretation of data, manuscript preparation; Lydersen S contributed to statistical analyses and interpretation of data, critically reviewed the manuscript; Ness-Jensen E contributed conception and design of the study, to interpretation of data, drafting the article and revising it critically for important intellectual content; Endreseth BH made substantial contributions to the conception of the study, interpretation of data, making critical revisions related to important intellectual content of the manuscript; Edna TH made substantial contributions to conception and design of the study, acquisition of data, analysis and interpretation of data; drafting the article; all authors read and approved the final manuscript.
Supported by Institute of Cancer Research and Molecular Medicine, The Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway; and the Department of Research, Levanger Hospital, Levanger.
Institutional review board statement: The present study is approved by the Regional Committee for Health and Research Ethics (2011/1782/REK midt).
Informed consent statement: The participants in HUNT2 gave written informed consent for medical research, including future linkage to patient records at the hospitals.
Conflict-of-interest statement: The authors declare the absence of conflict of interests.
Data sharing statement: Data from the HUNT Databank may be available after individual application from researchers to the Databank, see https://hunt-db.medisin.ntnu.no/hunt-db/.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tom-Harald Edna, MD, PhD, Professor, Surgeon, Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Postboks 8905, 7491 Trondheim, Norway.
tom-harald.edna@ntnu.no
Telephone: +47-74-098000 Fax: +47-74-098901
Received: August 3, 2016
Peer-review started: August 6, 2016
First decision: September 28, 2016
Revised: October 20, 2016
Accepted: November 23, 2016
Article in press: November 28, 2016
Published online: December 28, 2016
Processing time: 144 Days and 21.5 Hours
AIM
To assess risk factors of hospital admission for acute colonic diverticulitis.
METHODS
The study was conducted as part of the second wave of the population-based North Trondelag Health Study (HUNT2), performed in North Trondelag County, Norway, 1995 to 1997. The study consisted of 42570 participants (65.1% from HUNT2) who were followed up from 1998 to 2012. Of these, 22436 (52.7%) were females. The cases were defined as those 358 participants admitted with acute colonic diverticulitis during follow-up. The remaining participants were used as controls. Univariable and multivariable Cox regression analyses was used for each sex separately after multiple imputation to calculate HR.
RESULTS
Multivariable Cox regression analyses showed that increasing age increased the risk of admission for acute colonic diverticulitis: Comparing with ages < 50 years, females with age 50-70 years had HR = 3.42, P < 0.001 and age > 70 years, HR = 6.19, P < 0.001. In males the corresponding values were HR = 1.85, P = 0.004 and 2.56, P < 0.001. In patients with obesity (body mass index ≥ 30) the HR = 2.06, P < 0.001 in females and HR = 2.58, P < 0.001 in males. In females, present (HR = 2.11, P < 0.001) or previous (HR = 1.65, P = 0.007) cigarette smoking increased the risk of admission. In males, breathlessness (HR = 2.57, P < 0.001) and living in rural areas (HR = 1.74, P = 0.007) increased the risk. Level of education, physical activity, constipation and type of bread eaten showed no association with admission for acute colonic diverticulitis.
CONCLUSION
The risk of hospital admission for acute colonic diverticulitis increased with increasing age, in obese individuals, in ever cigarette smoking females and in males living in rural areas.
Core tip: We sought to determine what health related factors were together associated with later admission for acute colonic diverticulitis. The factors were derived from the North Trondelag Health Study (HUNT2) in Norway, the HUNT2 study, performed during 1995-1997. The study had 42570 participants who used Levanger Hospital as their primary hospital. They were observed until 2012. Following HUNT2, the participants contributed 611492 person-years of follow-up. In all, 358 cases had been admitted with acute colonic diverticulitis. In a multivariable analysis, increasing age and increasing Body Mass Index were associated with increased risk of admission for acute colonic diverticulitis in both gender. In females, cigarette smoking likewise increased the risk of admission. In males, breathlessness, a HUNT variable associated with Chronic Obstructive Pulmonary Disease, increased the risk of admission. On the other hand, physical activity, constipation and type of bread eaten showed no association with admission for acute colonic diverticulitis.
