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. 2020 Oct;18(11):2500-2509.e1.
doi: 10.1016/j.cgh.2020.01.023. Epub 2020 Jan 25.

Assessing National Trends and Disparities in Ambulatory, Emergency Department, and Inpatient Visits for Inflammatory Bowel Disease in the United States (2005-2016)

Christopher Ma  1 , Matthew K Smith  2 , Leonardo Guizzetti  3 , Remo Panaccione  4 , Gilaad G Kaplan  5 , Kerri L Novak  4 , Cathy Lu  4 , Reena Khanna  6 , Brian G Feagan  7 , Siddharth Singh  8 , Vipul Jairath  7 , Ashwin N Ananthakrishnan  9
Affiliations

Assessing National Trends and Disparities in Ambulatory, Emergency Department, and Inpatient Visits for Inflammatory Bowel Disease in the United States (2005-2016)

Christopher Ma et al. Clin Gastroenterol Hepatol. 2020 Oct.

Abstract

Background & aims: Patients with inflammatory bowel diseases (IBDs) require repeated health care encounters, although the focus of care differs when patients are seen in ambulatory, emergency department (ED), or inpatient settings. We examined contemporary trends and disparities in IBD-related health care visits.

Methods: We used data from the National Ambulatory Medical Care Survey, the Nationwide Emergency Department Sample, and the National Inpatient Sample to estimate the total number of annual IBD-related visits from 2005 through 2016. We performed logistic regression analyses to test temporal linear trends. Slope and differences in distributions of patient demographics were compared across time and treatment settings.

Results: From 2005 through 2016, approximately 2.2 million IBD-related ambulatory visits (95 CI, 1.9-2.5) occurred annually on average, increasing by 70.3% from the time period of 2005 to 2007 through the time period of 2008 to 2010, and decreasing by 19.8% from the time period of 2011 to 2013 through the time period of 2014 to 2016. An average of 115,934 IBD-related ED visits (95% CI, 113,758-118,111) and 89,111 IBD-related hospital discharges (95% CI, 87,416-90,807) occurred annually. Significant increases in the rate of IBD-related ED visits (3.2 visits/10,000 encounters; P < .0001) and hospital discharges (6.0 discharges/10,000 encounters; P < .0001) were observed from 2005 through 2016. The proportion of patients paying with private insurance decreased from 2005 through 2016, among all care settings. A greater proportion of young patients, patients with Crohn's disease, non-white patients, and patients with Medicare or Medicaid used hospital-based vs ambulatory services.

Conclusions: In an analysis of data from 3 large databases, we found that although IBD-related ambulatory visits stabilized to decreased from 2005 through 2016, rates of ED use and admission to the hospital have continued to increase with changes in patient demographics, over time and among care settings.

Keywords: Crohn’s Disease; Health Care Utilization; NAMCS; NEDS; NIS; Ulcerative Colitis.

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Conflict of interest statement

Conflicts of Interest:

Christopher Ma reports consulting fees from Robarts Clinical Trials, Janssen, and AbbVie and speaker’s fees from Janssen and Pfizer

Matthew Smith reports no conflicts of interest

Leonardo Guizzetti is an employee of Robarts Clinical Trials.

Remo Panaccione reports consulting fees from AbbVie, ActoGeniX, AGI Therapeutics, Alba Therapeutics Albireo, Alfa Wasserman, Amgen, AM-Pharma BV, Anaphore, Aptalis, Astellas, Athersys, Atlantic Healthcare, BioBalance, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, Celek, Cellerix, Cerimon, ChemoCentryx, CoMentis, Cosmo Technologies, Coronado Biosciences, Cytokine Pharmasciences, Eagle, Eisai Medical Research, Elan, EnGene, Eli Lilly, Enteromedics, Exagen Diagnostics, Ferring, Flexion Therapeutics, Funxional Therapeutics, Genentech, Genzyme, Gilead, Given Imaging, GlaxoSmithKline, Human Genome Sciences, Ironwood, Janssen, KaloBios, Lexicon, Lycera, Meda, Merck & Co., Merck Research Laboratories, MerckSerono, Millennium, Nisshin Kyorin, Novo Nordisk, NPS Pharmaceuticals, Optimer, Orexigen, PDL Biopharma, Pfizer, Procter and Gamble, Prometheus Laboratories, ProtAb, Purgenesis Technologies, Receptos, Relypsa, Salient, Salix, Santarus, Shire Pharmaceuticals, Sigmoid Pharma, Sirtris (a GSK company), S.L.A. Pharma (UK), Targacept, Teva, Therakos, Tillotts, TxCell SA, UCB Pharma, Vascular Biogenics, Viamet and Warner Chilcott UK; speaker’s fees from Abbvie, Allergan, AstraZeneca, Ferring, Janssen, Merck, Prometheus, Pfizer, Shire, Takeda; has served on advisory boards Abbvie, Abbott, Amgen, Aptalis, AstraZeneca, Baxter, Biogen Idec, Eisai, Ferring, Genentech, Janssen, Merck, Shire, Elan, Glaxo-Smith Kline, Hospira, Pfizer, Bristol-Myers Squibb, Takeda, Cubist, Celgene, Salix, and received research/educational Support from Abbvie, Ferring, Janssen, Shire, Takeda

Gilaad Kaplan reports consulting fees from Pfizer, Janssen, AbbVie, and Takeda

Kerri Novak reports advisory board fees from AbbVie, Janssen, Pfizer, Ferring; speaker’s fees from AbbVie, Janssen; and research support from AbbVie, Janssen

Cathy Lu reports consulting or advisory board fees from AbbVie, Ferring, Janssen, and Takeda

Reena Khanna reports consulting fees from AbbVie, Janssen, Merck, Takeda, Roche/Genetec AbbVie, Janssen, Merck, Takeda, Roche/Genetec, having served on an advisory board for AbbVie, Janssen, Merck, Takeda, Roche/Genetec, and Pfizer, and speaker’s fees from AbbVie, Janssen, Takeda, Shire, Pendopharm

Brian Feagan reports fees for serving on advisory boards from AbbVie, Allergan, Amgen, AstraZeneca, Avaxia Biologics, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Elan–Biogen, Ferring, Genentech–Roche, Janssen–Johnson &Johnson, Merck, Millennium, Nestlé, Novo Nordisk, Novartis, Pfizer, Prometheus, Protagonist, Receptos, Salix, Sigmoid Pharma, Takeda, Teva, TiGenix, Tillotts Pharma, and UCB Pharma, consulting fees from AbbVie, Actogenix, Akros, Albireo Pharma, Allergan, Amgen, AstraZeneca, Avaxia Biologics, Avir Pharma, Axcan, Baxter Healthcare, Biogen Idec, Boehringer Ingelheim, Bristol-Myers Squibb, Calypso Biotech, Celgene, Elan–Biogen, EnGene, Ferring, Genentech–Roche, GiCare Pharma, Gilead Sciences, Given Imaging, GlaxoSmithKline, Ironwood, Janssen Biotech–Centocor, Janssen–Johnson & Johnson, Kyowa Hakko Kirin, Eli Lilly, Merck, Mesoblast Pharma, Millennium, Nestlé, Novo Nordisk, Novartis, Pfizer, Prometheus, Protagonist, Receptos Salix, Sanofi, Shire, Sigmoid Pharma, Synergy Pharma, Takeda, Teva, TiGenix, Tillotts Pharma, UCB Pharma, Vertex, VHsquared, Wyeth, Zealand, and Zygenia, lecture fees from AbbVie, Janssen–Johnson & Johnson, Takeda, and UCB Pharma, and grant support from AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Janssen Biotech–Centocor, Janssen–Johnson & Johnson, Pfizer, Receptos, Sanofi, and Takeda, and being a consultant to Robarts Clinical Trials, Inc.

Siddharth Singh reports research support from Pfizer and AbbVie, consulting fees from AbbVie, Takeda, Pfizer, AMAG Pharmaceuticals

Vipul Jairath reports consulting fees from AbbVie, Eli Lilly, GlaxoSmithKline, Arena Pharmaceuticals, Genetech, Pendopharm, Sandoz, Merck, Takeda, Janssen, Robarts Clinical Trials Inc., Topivert, Celltrion, and speaker’s fees from Takeda, Janssen, Shire, Ferring, Abbvie and Pfizer

Ashwin Ananthakrishnan reports research support from Pfizer and served as an advisory board member for Abbvie, Janssen

Figures

Figure 1.
Figure 1.
Temporal trends in rates of inflammatory bowel disease-related ambulatory (A-C), emergency department (D-F) and inpatient (G-I) visits in the United States (2005-2016), stratified by disease type.
See this image and copyright information in PMC

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