Association Between Infections and Risk of Ankylosing Spondylitis: A Systematic Review and Meta-Analysis

Xiao Zhang; Zhe Sun; Aihong Zhou; Lei Tao; Yingxin Chen; Xinyu Shi; Jia Yin; Zheng Sun; Guoyong Ding

doi:10.3389/fimmu.2021.768741

Association Between Infections and Risk of Ankylosing Spondylitis: A Systematic Review and Meta-Analysis

Front Immunol. 2021 Oct 22:12:768741. doi: 10.3389/fimmu.2021.768741. eCollection 2021.

Authors

Xiao Zhang^{1

2

3}, Zhe Sun⁴, Aihong Zhou⁴, Lei Tao⁴, Yingxin Chen^{1

2}, Xinyu Shi^{1

2}, Jia Yin³, Zheng Sun², Guoyong Ding^{3

4}

Affiliations

¹ School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
² School of Clinical Medline, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
³ School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
⁴ The Second Affiliated Hospital of Shandong First Medical University, Taian, China.

Abstract

Background: Previous literature on the association between infections and the risk of developing ankylosing spondylitis (AS) presented controversial results. This meta-analysis aimed to quantitatively investigate the effect of infections on the risk of AS.

Methods: We searched the PubMed, Embase, and Web of Science databases until March 26, 2021 for analytical epidemiological studies on the association between infections and the risk of AS. Fixed or random effect models were used to calculate total risk estimates based on study heterogeneity. Subgroup analysis, and sensitivity analysis were also performed. Publication bias was estimated using funnel plots and Begg's test.

Results: Six case-control articles (n=1,296,239) and seven cohort articles (n=7,618,524) were incorporated into our meta-analysis. The pooled odds ratio (OR) from these case-control studies showed that infections were associated with an increased risk of AS (OR=1.46, 95% confidence interval [CI], 1.23-1.73), and the pooled relative risk (RR) from the cohort studies showed the same findings (RR=1.35, 95% CI, 1.12-1.63). Subgroup analysis showed that infections in participants with unadjusted comorbidities (OR=1.66, 95% CI, 1.35-2.03), other types of infection (OR=1.40, 95% CI, 1.15-1.70), and infection of the immune system (OR=1.46, 95% CI, 1.42-1.49) were associated with the risk of AS in case-control studies. In cohort studies, infections with adjusted comorbidities (RR=1.39, 95% CI, 1.15-1.68), viral infection (RR=1.43, 95% CI, 1.22-1.66), other types of infection (RR=1.44, 95% CI, 1.12-1.86), and other sites of infection (RR=1.36, 95% CI, 1.11-1.67) were associated with an increased risk of AS.

Conclusions: The findings of this meta-analysis confirm that infections significantly increase the risks of AS. This is helpful in providing an essential basis for the prevention of AS via the avoidance of infections.

Keywords: analytical epidemiology; ankylosing spondylitis; infections; meta-analysis; systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Humans
Infections / complications*
Publication Bias
Risk
Spondylitis, Ankylosing / etiology*