Background

The odds ratio (OR) comparing pathogen presence in diarrhoeal cases versus asymptomatic controls is a measure for diarrhoeal disease cause that has been integrated into burden of disease estimates across diverse populations. This study aimed to estimate the OR describing the association between pathogen detection in stool and diarrhoea for 15 common enteropathogens by age group and child mortality setting.

Methods

We did a systematic review to identify case-control and cohort studies published from Jan 1, 1990, to July 9, 2019, which examined at least one enteropathogen of interest and the outcome diarrhoea. The analytical dataset included data extracted from published articles and supplemented with data from the Global Enteric Multicenter Study and the Malnutrition and Enteric Disease study. Random effects meta-analysis models were fit for each enteropathogen, stratified by age group and child mortality level, and adjusted for pathogen detection method and study design to produce summary ORs describing the association between pathogen detection in stool and diarrhoea.

Findings

1964 records were screened and 130 studies (over 88 079 cases or diarrhoea samples and 135 755 controls or non-diarrhoea samples) were available for analysis. Heterogeneity (I²) in unadjusted models was substantial, ranging from 27·6% to 86·6% across pathogens. In stratified and adjusted models, summary ORs varied by age group and setting, ranging from 0·4 (95% CI 0·2–0·6) for Giardia lamblia to 54·1 (95% CI 7·4–393·5) for Vibrio cholerae.

Interpretation

Incorporating effect estimates from diverse data sources into diarrhoeal disease cause and burden of disease models is needed to produce more representative estimates.

Funding

WHO, Bill & Melinda Gates Foundation, and National Institutes of Health.

中文翻译：

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按年龄和高与低儿童死亡率环境划分的肠道病原体检测与腹泻的关联：系统评价和荟萃分析

 背景

比较腹泻病例与无症状对照中病原体存在的比值比 (OR) 是腹泻疾病病因的衡量标准，已纳入不同人群的疾病负担估计中。本研究旨在评估 OR，描述按年龄组和儿童死亡率设置的 15 种常见肠道病原体粪便中病原体检测与腹泻之间的关联。

 方法

我们进行了系统回顾，以确定 1990 年 1 月 1 日至 2019 年 7 月 9 日发表的病例对照和队列研究，这些研究检查了至少一种感兴趣的肠道病原体和腹泻结果。分析数据集包括从已发表的文章中提取的数据，并补充了全球肠道多中心研究和营养不良与肠道疾病研究的数据。随机效应荟萃分析模型适合每种肠道病原体，按年龄组和儿童死亡率水平分层，并根据病原体检测方法和研究设计进行调整，以生成描述粪便中病原体检测与腹泻之间关联的总结 OR。

 发现

筛选了 1964 份记录，并有 130 项研究（超过 88 079 例病例或腹泻样本和 135 755 份对照或非腹泻样本）可供分析。未经调整的模型中，不同病原体的异质性 ( I ² ) 很大，范围为 27·6% 至 86·6%。在分层和调整模型中，汇总 OR 因年龄组和环境而异，范围从贾第鞭毛虫的0·4 (95% CI 0·2–0·6) 到 54·1 (95% CI 7·4–393·5) ）针对霍乱弧菌。

 解释

需要将不同数据源的效应估计纳入腹泻病原因和疾病负担模型中，以产生更具代表性的估计。

 资金

世界卫生组织、比尔及梅琳达·盖茨基金会和美国国立卫生研究院。