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Comparative Study
. 2018 Aug;155(2):469-478.e1.
doi: 10.1053/j.gastro.2018.04.013. Epub 2018 Apr 13.

Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007-2014

Affiliations
Comparative Study

Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007-2014

Zachary M Sellers et al. Gastroenterology. 2018 Aug.

Abstract

Background & aims: Epidemiologic analyses of acute pancreatitis (AP) and chronic pancreatitis (CP) provide insight into causes and strategies for prevention and affect allocation of resources to its study and treatment. We sought to determine current and accurate incidences of AP and CP, along with the prevalence of CP, in children and adults in the United States.

Methods: We collected data from the Truven MarketScan Research Databases of commercial inpatient and outpatient insurance claims in the United States from 2007 through 2014 (patients 0-64 years old). We calculated the incidences of AP and CP and prevalence of CP based on International Classification of Diseases, 9th Revision diagnosis codes. Children were defined as 18 years or younger and adults as 19 to 64 years old.

Results: The incidence of pediatric AP was stable from 2007 through 2014, remaining at 12.3/100,000 persons in 2014. Meanwhile, the incidence for adult AP decreased from 123.7/100,000 persons in 2007 to 111.2/100,000 persons in 2014. The incidence of CP decreased over time in children (2.2/100,000 persons in 2007 to 1.9/100,000 persons in 2014) and adults (31.7/100,000 persons in 2007 to 24.7/100,000 persons in 2014). The prevalences of pediatric and adult CP were 5.8/100,000 persons and 91.9/100,000 persons, respectively, in 2014. Incidences of AP and CP increased with age. We found little change in incidence during the first decade of life but linear increases starting in the second decade.

Conclusions: We performed a comprehensive epidemiologic analysis of privately insured, non-elderly adults and children with AP and CP in the United States. Changes in gallstone formation, smoking, and alcohol consumption, along with advances in pancreatitis management, may be responsible for the stabilization and even decrease in the incidences of AP and CP.

Keywords: Epidemiology; Inflammation; Pancreas; Trends.

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Figures

Figure 1
Figure 1. Determination of Pediatric and Adult Acute and Chronic Pancreatitis Cohorts
Outpatient and inpatient encounters from 2007–2014 were used from the Truven Health MarketScan Commercial Databases. Using both databases resulted in a total of 141,017,841 unique patients. Patients with AP or CP were identified by their respective ICD-9 diagnosis codes. A subset of patients had dual AP and CP codes on the same day. These represented 0.4% of the pancreatitis cohort and were excluded. These cohorts were further divided into pediatric or adult groups based on age at time of diagnosis.
Figure 2
Figure 2. Geographical Distribution of Persons in the Truven Health MarketScan Commercial Databases in the United States in 2014
Each color represents the number of persons in the database that are located within each of the defined metropolitan statistical areas (MSA) in 2014. White regions represent rural areas where patients may have been present, but no MSA information exists, whereas grey regions represent places without patient representation in the database in 2014.
Figure 3
Figure 3. Trends in the Incidence of Pediatric and Adult Acute Pancreatitis from 2007–2014
A. Incidence of pediatric (black) or adult (grey) AP for each year from 2007–2014. Lines represent regression trend lines for each group with the incidence for 2014 represented in text. B. Comparison of AP incidence by age between 2007 (black) and 2014 (grey). Circles represent incidence for each age, with the line being the best fit regression line.
Figure 4
Figure 4. Trends in the Incidence of Pediatric and Adult Chronic Pancreatitis from 2007–2014
A. Left: Incidence of pediatric (black) or adult (grey) CP for each year from 2007–2014. Lines represent regression trend lines for each group with the incidence for 2014 represented in text. Right: Prevalence of (black) and adult (grey) CP in 2014. B. Comparison of CP incidence by age between 2007 (black) and 2014 (grey). Circles represent incidence for each age, with the line being the best fit regression line.

Comment in

  • National Trends in Acute and Chronic Pancreatitis Needs to Be Improved.
    Hao L, Li ZS, Hu LH. Hao L, et al. Gastroenterology. 2019 Jan;156(1):287. doi: 10.1053/j.gastro.2018.06.095. Epub 2018 Oct 10. Gastroenterology. 2019. PMID: 30315779 No abstract available.
  • Reply.
    Sellers ZM. Sellers ZM. Gastroenterology. 2019 Jan;156(1):287-288. doi: 10.1053/j.gastro.2018.11.045. Epub 2018 Nov 22. Gastroenterology. 2019. PMID: 30472228 No abstract available.

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