Cohort profile: ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden)

Abstract

The ESPRESSO study constitutes a novel approach to examine the etiology and prognosis of gastrointestinal disease in which histopathology plays a prominent role. Between 2015 and 2017, all pathology departments (n=28) in Sweden were contacted and asked to procure histopathology record data from the gastrointestinal tract (pharynx to anus), liver, gallbladder, and pancreas. For each individual, local histopathology IT personnel retrieved data on personal identity number, date of histopathology, topography (where the biopsy is taken), morphology (biopsy appearance), and where available free text. In total, between 1965 and 2017, histopathology record data were available in 2.1 million unique individuals, but the number of data entries was 6.1 million because more than one biopsy was performed in many of the study participants. Index individuals with histopathology data were matched with up to five controls from the general population. We also identified all first-degree relatives (parents, children, full siblings), and the index individual’s first spouse. The total study population consisted of 13.0 million individuals. Data from all the study participants have been linked to Swedish National Healthcare Registers allowing research not only on such aspects as fetal and perinatal conditions and the risk of future gastrointestinal disease but also on the risk of comorbidity and complications (including cancer and death). Furthermore, the ESPRESSO database allows researchers and practitioners to identify diagnoses and disease phenotypes not currently indexed in national registers (including disease precursors). The ESPRESSO database increases the sensitivity and specificity of already-recorded diseases in the national health registers. This paper is an overview of the ESPRESSO database.

Inflammatory bowel disease and pancreatic cancer: a Scandinavian register‐based cohort study 1969‐2017

“…Due to population‐based setting, our results should be highly generalisable to similar populations. Access to histopathology data helped define IBD onset better than in previous reports 21,39 . Unlike some earlier studies using standardised incidence ratios (which might underestimate the relative risk since reference individuals could be diagnosed with cancer before study entry whereas IBD cases could not), our comparisons of cancer incidence were based on a matched reference cohort drawn from the general population.…”

“…We used the International Classification of Disease (ICD) codes (Table S3) in the National Patient Registers (Table S2) to identify incident cases with IBD (in Denmark between January 1979 and December 2011 and in Sweden between January 1969 and December 2017). We requested either ≥2 records of IBD in the National Patient Registers 38 or ≥1 record of IBD in the National Patient Registers plus a colorectal biopsy record suggestive of IBD from the Swedish ESPRESSO Biopsy Register or the Danish Pathology Register 39 . The IBD subtype definition was based on the first two diagnostic listings, and patients with listings of both Crohn's disease and ulcerative colitis, or a listing of IBD unclassified (IBD‐U) were defined as IBD‐U, and included in the IBD group 40 …”

A nationwide cohort study of the incidence of microscopic colitis in Sweden

“…For this study, the 28 Swedish pathology departments submitted data on all biopsies coded M47170 for lymphocytic colitis and M40600 for collagenous colitis. These data were collected as part of the greater ESPRESSO‐study . Using these data, we created a nationwide cohort of patients with a first diagnosis of microscopic colitis in Sweden during 1995‐2015.…”

Mortality of Patients With Microscopic Colitis in Sweden

“…Adult patients, !18 years of age, with a diagnosis of microscopic colitis were identified from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study. 9 Briefly, the ESPRESSO study is a nationwide histopathology database established in 2018 that includes data on gastrointestinal-related biopsies from all 28 pathology departments in Sweden from January 1965 to December 2017. Patients with microscopic colitis were identified from these pathology reports, which included personal identity number, date of biopsy, topography (colorectal: T67-T68), and morphology according to the SNOMED (Systematized Nomenclature of Medicine) system (collagenous colitis: M40600 and lymphocytic colitis: M47170) (Supplementary Table 1).…”

“…However, such studies would have important public health implications, as the incidence of the disease is rising, particularly in the more vulnerable elderly population. 2 Leveraging a large nationwide pathology database in Sweden, 9 we sought to examine the association between microscopic colitis including its histologic subtypes of lymphocytic and collagenous colitis and risk of all-cause and cause-specific death. This cohort was particularly unique, as it allowed us to link pathology reports from all 28 centers in Sweden over more than 20 years 9 to nationwide patient and prescription registries to compare the mortality rate of histologically confirmed microscopic colitis cases with that of the general population comparators.…”