ArticleThe American journal of gastroenterology2014
Esophageal eosinophilia is increased in rural areas with low population density: results from a national pathology database.
Article in The American journal of gastroenterology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 1 of them a synthesis that pooled it.
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Who cites it
48 citing papers in PubMed, 1 synthesis or guideline pooled it, 101 citations in OpenAlex.
- The Role of Environmental Exposures in the Etiology of Eosinophilic Esophagitis: A Systematic Review.Mayo Clinic proceedings · 2015Pooled it
- Eosinophilic gastrointestinal diseases.Nature reviews. Disease primers · 2026Review
- Socioeconomic Deprivation Does Not Influence Disease Severity or Access to Dupilumab in Eosinophilic Esophagitis.Gastroenterology research · 2026Article
- Recommendations for the diagnosis and management of eosinophilic esophagitis in adults and children in Canada: a Delphi consensus project.Journal of the Canadian Association of Gastroenterology · 2025Review
- Recommendations for the diagnosis and management of eosinophilic esophagitis in adults and children in Canada: a Delphi consensus project.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2025Review
- Eosinophilic gastroduodenitis: a pediatric perspective.Italian journal of pediatrics · 2025Review
- Rural Environment as a Risk Factor for the Age at Onset of Machado-Joseph Disease.Movement disorders clinical practice · 2025Article
- [Eosinophilic esophagitis].Innere Medizin (Heidelberg, Germany) · 2025Review
- Particulate matter as a possible risk factor for eosinophilic esophagitis.Frontiers in allergy · 2025Article
- Exploring the Impact of Gender on the Characteristics and Complications of Eosinophilic Esophagitis.JGH open : an open access journal of gastroenterology and hepatology · 2024Article
- Off-Label Use of Monoclonal Antibodies for Eosinophilic Esophagitis in Humans: A Scoping Review.Biomedicines · 2024Article
- Eosinophilic esophagitis: Current concepts in diagnosis and management.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2024Review
- Barriers to Timely Diagnosis of Eosinophilic Gastrointestinal Diseases.The journal of allergy and clinical immunology. In practice · 2024Article
- Review article: Emerging insights into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis and other eosinophilic gastrointestinal diseases.Alimentary pharmacology & therapeutics · 2024Review
- Article
- Proximity to Swine Farming Operations as a Risk Factor for Eosinophilic Esophagitis.JPGN reports · 2023Article
- Early life exposures as risk factors for non-esophageal eosinophilic gastrointestinal diseases.Clinics and research in hepatology and gastroenterology · 2023Article
- Nature with Nurture: the Role of Intrinsic Genetic and Extrinsic Environmental Factors on Eosinophilic Esophagitis.Current allergy and asthma reports · 2022Review
- First Therapeutic Approval for Eosinophilic Esophagitis.Gastroenterology insights · 2022Article
- EoE CONNECT, the European Registry of Clinical, Environmental, and Genetic Determinants in Eosinophilic Esophagitis: rationale, design, and study protocol of a large-scale epidemiological study in Europe.Therapeutic advances in gastroenterology · 2022Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesEosinophilic esophagitis (EoE) is an increasingly prevalent chronic disease arising from an allergy/immune-mediated process. Generally, the risk of atopic disease differs in rural and urban environments. The relationship between population density and EoE is unknown. Our aim was to assess the relationship between EoE and population density.
methodsWe conducted a cross-sectional, case-control study of patients with esophageal biopsies in a US national pathology database between January 2009 and June 2012 to assess the relationship between population density and EoE. Using geographic information systems, the population density (individuals per square mile) was determined for each patient zip code. The odds of esophageal eosinophilia and EoE were estimated for each quintile of population density and adjusted for potential confounders. Sensitivity analyses were conducted with varying case definitions and to evaluate the potential for bias from endoscopy volume and patient factors.
resultsOf 292,621 unique patients in the source population, 89,754 had normal esophageal biopsies and 14,381 had esophageal eosinophilia with ≥15 eosinophils per high-power field. The odds of having esophageal eosinophilia increased with decreasing population density (P for trend <0.001). Compared with those in the highest quintile of population density, odds of having esophageal eosinophilia were significantly higher among those in the lowest quintile of population density (adjusted odds ratio (aOR) 1.27, 95% confidence interval (CI): 1.18, 1.36). A similar dose-response trend was observed across case definitions with increased odds of EoE in the lowest population density quintile (aOR 1.59, 95% CI: 1.45-1.76). Estimates were robust to sensitivity analyses.
conclusionsPopulation density is strongly and inversely associated with esophageal eosinophilia and EoE. This association is robust to varying case definitions and adjustment factors. Environmental exposures that are more prominent in rural areas may be relevant to the pathogenesis of EoE.
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