TY - JOUR
T1 - Sex Differences in Long-term Outcomes After Group B Streptococcal Infections During Infancy in Denmark and the Netherlands
T2 - National Cohort Studies of Neurodevelopmental Impairments and Mortality
AU - GBS Danish and Dutch collaborative group for long term outcomes
AU - van Kassel, Merel N
AU - Gonçalves, Bronner P
AU - Snoek, Linde L
AU - Sørensen, Henrik T
AU - Bijlsma, Merijn W
AU - Lawn, Joy E
AU - Horváth-Puhó, Erzsébet
AU - van de Beek, Diederik
AU - GBS Danish and Dutch Collaborative Group for Long-term Outcomes
N1 - Publisher Copyright: © 2021 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2022/1/15
Y1 - 2022/1/15
N2 - BACKGROUND: Male infants have a higher incidence of invasive group B Streptococcus disease (iGBS) compared with female infants; however, data on sex differences in mortality and long-term outcomes after iGBS are lacking. We assessed whether a child's sex influences the effects of iGBS on mortality and risk of neurodevelopmental impairments (NDIs). METHODS: We used Danish and Dutch registry data to conduct a nationwide cohort study of infants with a history of iGBS. A comparison cohort, children without a history of iGBS, was randomly selected and matched on relevant factors. Effect modification by sex was assessed on additive and multiplicative scales. RESULTS: Our analyses included data from children with a history of iGBS in Denmark (period 1997 -2017; n = 1432) and the Netherlands (2000 -2017; n = 697) and from 21 172 children without iGBS. There was no clear evidence of between-sex heterogeneity in iGBS-associated mortality. Boys had a higher risk of NDI, with evidence for effect modification on additive scale at the age of 5 years for any NDI (relative excess risk due to interaction = 1.28; 95% confidence interval [CI], -0.53 to 3.09 in Denmark and 1.14; 95% CI, -5.13 to 7.41 in the Netherlands). A similar pattern was observed for moderate/severe NDI at age 5 years in Denmark and age 10 years in the Netherlands. CONCLUSION: Boys are at higher risk of NDI ; our results suggest this is disproportionally increased in those who develop iGBS. Future studies should investigate mechanisms of this effect modification by sex.
AB - BACKGROUND: Male infants have a higher incidence of invasive group B Streptococcus disease (iGBS) compared with female infants; however, data on sex differences in mortality and long-term outcomes after iGBS are lacking. We assessed whether a child's sex influences the effects of iGBS on mortality and risk of neurodevelopmental impairments (NDIs). METHODS: We used Danish and Dutch registry data to conduct a nationwide cohort study of infants with a history of iGBS. A comparison cohort, children without a history of iGBS, was randomly selected and matched on relevant factors. Effect modification by sex was assessed on additive and multiplicative scales. RESULTS: Our analyses included data from children with a history of iGBS in Denmark (period 1997 -2017; n = 1432) and the Netherlands (2000 -2017; n = 697) and from 21 172 children without iGBS. There was no clear evidence of between-sex heterogeneity in iGBS-associated mortality. Boys had a higher risk of NDI, with evidence for effect modification on additive scale at the age of 5 years for any NDI (relative excess risk due to interaction = 1.28; 95% confidence interval [CI], -0.53 to 3.09 in Denmark and 1.14; 95% CI, -5.13 to 7.41 in the Netherlands). A similar pattern was observed for moderate/severe NDI at age 5 years in Denmark and age 10 years in the Netherlands. CONCLUSION: Boys are at higher risk of NDI ; our results suggest this is disproportionally increased in those who develop iGBS. Future studies should investigate mechanisms of this effect modification by sex.
KW - Streptococcus agalactiae
KW - effect modification
KW - group B Streptococcus
KW - neurodevelopmental impairments
KW - sex differences
UR - http://www.scopus.com/inward/record.url?scp=85123813308&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/cid/ciab822
DO - https://doi.org/10.1093/cid/ciab822
M3 - Article
C2 - 34725694
SN - 1058-4838
VL - 74
SP - S54-S63
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -