title: Infectious causation of chronic disease: examining the relationship between Giardia lamblia infection and irritable bowel syndrome.
abstract: OBJECTIVE
  To evaluate whether a higher prevalence of Giardia lamblia infection is associated with an increase in irritable bowel syndrome (IBS) prescriptions at the county level in Michigan.
  
  
  METHODS
  The Michigan Disease Surveillance System (MDSS) was used to ascertain both the numbers of Giardia lamblia infections as well as the total number of foodborne illnesses per population by county in Michigan during 2005. This was compared with Blue Cross Blue Shield (BCBS) of Michigan numbers of drug prescriptions for IBS per one thousand members per county in 2005. These data were also analyzed for associations with per capita income by county and the number of refugees entering each county in 2005.
  
  
  RESULTS
  There were a total of 786 confirmed cases of Giardia lamblia reported to MDSS in 2005. During the same time period, the number of prescriptions for IBS varied from 0.5 per 1000 members up to 6.0 per 1000 members per month. There was no trend towards higher numbers of IBS prescriptions in the counties with more Giardia lamblia infections. Per capita income was not associated with either IBS prescriptions or Giardiasis. There was a significant linear association between the number of refugees entering each county, and the number of Giardia lamblia cases per 100,000 population.
  
  
  CONCLUSIONS
  In this ecological study, there was no association found between BCBS prescriptions for IBS and Giardia lamblia infections in Michigan counties. Our findings may have been influenced by the disparate number of refugees admitted per county.
authors.affiliation: University of Michigan Preventive Medicine Residency, Ann Arbor, Michigan 48109-2029, USA. apenrose@umich.edu
authors.forename: Alice S
authors.initials: AS
authors.lastname: Penrose
authors.forename: Eden V
authors.initials: EV
authors.lastname: Wells
authors.forename: Allison E
authors.initials: AE
authors.lastname: Aiello
mesh_terms: D000818:Animals; D054598:Blue Cross Blue Shield Insurance Plans / Q000706:statistics & numerical data; D019992:Databases as Topic; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D016829:Giardia lamblia; D005873:Giardiasis / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D043183:Irritable Bowel Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology*; D008824:Michigan / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D012036:Refugees / Q000706:statistics & numerical data; D012959:Socioeconomic Factors