Unraveling Genetic Versus Environmental Factors Determining Disease Course in Inflammatory Bowel Diseases: A Population-Based Cohort Study in First- and Second-Generation Immigrants
Bibliographic record
Abstract
BACKGROUND: Inflammatory bowel diseases (IBD) incidence in immigrants approximates that of the host country in progressive generations but less is known about their disease outcome. We investigate how the immigrant generation affects IBD outcomes. METHODS: In this population-based cohort study, the risks of first IBD-related hospitalization, first IBD-related surgery, need for advanced therapies, and perianal disease were compared between first- and second-generation immigrants (stratified into Western/non-Western) and native Danes, using Cox proportional hazard regression to estimate adjusted hazard ratios (aHRs), correcting for sex, age at IBD diagnosis, and calendar year of IBD diagnosis. RESULTS: First-generation immigrants had lower risk of IBD-related surgery (aHRWestern 0.89; 95% confidence interval [CI] 0.75-1.05, aHRnon-Western 0.79; 95% CI, 0.67-0.92) and advanced therapy (aHRWestern 0.87; 95% CI, 0.77-0.99, aHRnon-Western 0.83; 95% CI, 0.74-0.94) than native Danes, whereas second-generation immigrants resembled native Danes. However, second-generation immigrants had higher risk of hospitalization than native Danes (aHRWestern 1.28; 95% CI, 1.05-1.55, aHRnon-Western 1.40; 95% CI, 1.28-1.54), whereas in first-generation immigrants this was only observed in non-Western ulcerative colitis patients (aHR 1.19; 95% CI, 1.08-1.32). Across both generations, non-Western immigrants had higher risk of perianal disease (Crohn's disease: aHRfirst-generation 1.55; 95% CI, 1.25-1.92; aHRsecond-generation 1.58; 95% CI, 1.25-2.01). CONCLUSIONS: Disease outcomes change across immigrant generations, pointing to environmental factors possibly impacting disease course, which needs further investigation. In contrast, non-Western immigrants were shown to have more perianal disease in both generations, suggesting a genetic susceptibility for this debilitating phenotype.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".