Increasing hospitalizations in inflammatory bowel disease among children in the United States, 1988-2011

Abstract

Background: Our objective was to characterize national trends in inflammatory bowel disease (IBD)-related hospitalizations for children. We hypothesized that over time, improvements in care would be associated with a decrease in hospitalization rates, similar to what has been observed in Canadian children with IBD.

Methods: Retrospective, serial, cross-sectional analysis of annual, nationally representative samples of children with IBD.

Results: Overall, discharges for all children irrespective of diagnosis decreased from 1988 to 2011 (P for trend <0.001). In contrast, discharges for children with IBD rose over the same time period from 6.1 (95% confidence interval [CI], 4.0-8.2) to 8.2 (95% CI, 5.5-10.9) per 100,000 individuals per year (P for trend <0.001). More of this rise occurred in hospitalizations that did not have IBD-related endoscopy or surgery performed (P for trend <0.001). Although mean length of stay decreased over the study period (P for trend <0.001), total hospital days increased over the latter half of the study with a significant increase over the entire study period (P for trend <0.001).

Conclusions: Contrary to clinically informed hypotheses, nationally representative rates of hospitalization for pediatric patients with IBD have increased since the mid-1990s. This directly contrasts with stable rates over the preceding years. Most of the expansion in hospital care seems to be related to hospitalizations that do not include procedures. Several lines of future research may greatly facilitate a better understanding of the epidemiologic, therapeutic, and health care resource issues at play.

FIGURE 1. Total hospitalizations with any diagnosis, 1 to 17 years old

Overall, discharges decreased from 1988 to 2011 (P for trend <0.001). Each upper and lower bound traces (dotted lines) represent 2 SEs from the mean, as 95% CIs were not available from HCUPnet.

FIGURE 2. IBD hospitalizations, 1 to 17 years old

In contrast to the overall trend, discharges for children with IBD increased from 6.1 (95% CI, 4.0–8.2) per 100,000 per year in 1988 to 8.2 (95% CI, 5.5–10.9) per 100,000 per year in 2011 (P for trend <0.001).

FIGURE 3. Hospitalizations with and without surgeries

Both hospitalizations with and without surgeries significantly increased over the study period (Ps for trend <0.001), but the rate in rise is more evident in those hospitalizations without surgery.

FIGURE 4. Hospitalizations without surgeries, by endoscopy

Among hospitalizations without surgeries, those without endoscopy rose significantly (P for trend <0.001), whereas those with endoscopy did not significantly change over the study period (P for trend = 0.078).

FIGURE 5. Hospital length of stay and total hospital days

Mean lengths of stay for IBD-related hospital care decreased over the study period from 10.5 (95% CI, 8.8–12.2) to 6.3 days (95% CI, 5.8–6.8; P for trend <0.001). IBD-related total hospital days were 79 (95% CI, 66–91) per 100,000 individuals per year in 1988. Total hospital days decreased to 46 (42–50) per 100,000 per year in 1995 (P for trend <0.001, 1988–1995), before increasing through the end of the study period to 78 (95% CI, 72–84; P for trend <0.001, 1996–2011). Of note, the overall trend in hospital days rose significantly from 1988 to 2011 (P for trend <0.001).