Prevalence of Inflammatory Bowel Disease Among Medicare Fee-For-Service Beneficiaries - United States, 2001-2018

Abstract

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is characterized by chronic inflammation of the gastrointestinal tract. The number of affected persons worldwide has increased from 3.7 million in 1990 to 6.8 million in 2017 (1). The disease is more prevalent among non-Hispanic White persons than it is among persons in other racial/ethnic groups (2). As the prevalence increases with age group (2), it is important to understand the disease epidemiology among the older population. CDC analyzed 2018 Medicare data among beneficiaries aged ≥67 years to examine differences by demographic characteristics for both diseases and to assess trends of prevalence from 2001 through 2018 both overall and by race and ethnicity. In 2018, 0.40% and 0.64% of 25.1 million Medicare fee-for-service beneficiaries aged ≥67 years had received a diagnosis of either Crohn's disease or ulcerative colitis. Prevalence varied by age, sex, race and ethnicity, urban-rural residency, and state. During 2001-2018, the age-adjusted prevalence of both diseases increased (Crohn's disease annual percentage change [APC] = 3.4%, ulcerative colitis APC = 2.8%). The increase was higher among non-Hispanic Black persons (Crohn's disease APC = 5.0%, ulcerative colitis APC = 3.5%) than it was among non-Hispanic White, Hispanic, and Asian/Pacific Islander (A/PI) persons. Prevalence was consistently highest among non-Hispanic White persons for both diseases and lowest among A/PI persons for Crohn's disease. The study findings of increasing prevalence in all racial/ethnic groups among older adults, especially the higher rate of increase among certain racial/ethnic minority groups, underscore the importance for promoting health equity, guiding efforts to tailor disease management strategies for different populations, and continuing to monitor the temporal trends of the disease.

FIGURE 1

Age-adjusted prevalence*^,† of Crohn’s disease and ulcerative colitis among 25.1 million Medicare fee-for-service beneficiaries — United States, 2018 * Age-adjusted to the 2000 U.S. Census population aged ≥67 years based on three age groups (67–74, 75–84, and ≥85 years). https://data.census.gov/cedsci/table?t=Age%20and%20Sex&y=2000&d=DEC%20Summary%20File%201&tid=DECENNIALSF12000.PCT012&hidePreview=false ^† State-level age-adjusted prevalence estimate (%) was categorized into tertiles.

FIGURE 2

Age-adjusted prevalence^,† of Crohn’s disease and ulcerative colitis among Medicare fee-for-service beneficiaries — United States, 2001—2018 Abbreviation: APC = annual percentage change. * Age-adjusted to the 2000 U.S. Census population aged ≥67 years based on three age groups (67–74, 75–84, and ≥85 years). https://data.census.gov/cedsci/table?t=Age%20and%20Sex&y=2000&d=DEC%20Summary%20File%201&tid=DECENNIALSF12000.PCT012&hidePreview=false ^† Trends in age-adjusted prevalence estimates were assessed in linear regressions weighted with the estimates-associated inversed standard errors. The estimated prevalence was natural logarithm transformed. For Crohn’s disease, APC = 3.4% for overall, 3.5% for non-Hispanic White persons, 5.0% for non-Hispanic Black persons, 3.2% for Hispanic persons, 2.7% for Asian/Pacific Islander persons, and 5.3% for American Indian/Alaska Native persons. For ulcerative colitis, APC = 2.8% for overall, 2.9% for non-Hispanic White persons, 3.5% for non-Hispanic Black persons, 2.5% for Hispanic persons, 1.8% for Asian/Pacific Islander persons, and 1.5% for American Indian/Alaska Native persons. All were statistically significant (p<0.001). ^§ The conversion from the International Classification of Diseases, Ninth Revision diagnosis codes to the International Classification of Diseases, Tenth Revision diagnosis codes occurred on October 1, 2015.