. 2023 Oct 3;29(10):1536-1545.

doi: 10.1093/ibd/izad020.

Hospitalization Rates for Inflammatory Bowel Disease Are Decreasing Over Time: A Population-based Cohort Study

Michael J Buie^{1

2}, Stephanie Coward^{1

2}, Abdel-Aziz Shaheen^{1

2}, Jayna Holroyd-Leduc^{1

2}, Lindsay Hracs^{1

2}, Christopher Ma^{1

3}, Remo Panaccione^{2

3}, Eric I Benchimol^{4

5

6

7

8}, Charles N Bernstein⁹, Alain Bitton¹⁰, Anthony R Otley¹¹, Jennifer L Jones¹², Sanjay K Murthy^{13

14

15

16}, M Ellen Kuenzig^{4

5}, Juan-Nicolás Peña-Sánchez¹⁷, Laura E Targownik¹⁸, Harminder Singh^{19

20}, Antonio Avina-Zubieta²¹, Gilaad G Kaplan^{1

2}

Affiliations

¹ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
² Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
³ Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁵ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁷ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
⁸ Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
⁹ Department of Medicine, and the University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁰ Division of Gastroenterology and Hepatology, McGill University and McGill University Health Centre, Montreal, Quebec, Canada.
¹¹ Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
¹² Division of Digestive Care & Endoscopy, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
¹³ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
¹⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹⁶ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
¹⁷ Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁸ Zane Cohen Centre for Digestive Diseases, Mount Sinai Health, Toronto, Ontario, Canada.
¹⁹ Departments of Medicine and Community Health Sciences, University of Manitoba, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
²⁰ Research Institute, CancerCare, Winnipeg, Manitoba, Canada.
²¹ Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 36917200
PMCID: PMC10547231
DOI: 10.1093/ibd/izad020

Hospitalization Rates for Inflammatory Bowel Disease Are Decreasing Over Time: A Population-based Cohort Study

Michael J Buie et al. Inflamm Bowel Dis. 2023.

. 2023 Oct 3;29(10):1536-1545.

doi: 10.1093/ibd/izad020.

Authors

Affiliations

¹ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
² Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
³ Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁵ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁷ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
⁸ Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
⁹ Department of Medicine, and the University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁰ Division of Gastroenterology and Hepatology, McGill University and McGill University Health Centre, Montreal, Quebec, Canada.
¹¹ Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
¹² Division of Digestive Care & Endoscopy, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
¹³ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
¹⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹⁶ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
¹⁷ Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁸ Zane Cohen Centre for Digestive Diseases, Mount Sinai Health, Toronto, Ontario, Canada.
¹⁹ Departments of Medicine and Community Health Sciences, University of Manitoba, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
²⁰ Research Institute, CancerCare, Winnipeg, Manitoba, Canada.
²¹ Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 36917200
PMCID: PMC10547231
DOI: 10.1093/ibd/izad020

Abstract

Background: Recent advances in the management of inflammatory bowel disease (IBD) striving for new treatment targets may have decreased rates of hospitalization for flares. We compared all-cause, IBD-related, and non-IBD-related hospitalizations while accounting for the rising prevalence of IBD.

Methods: Population-based, administrative health care databases identified all individuals living with IBD in Alberta between fiscal year 2002 and 2018. Hospitalization rates (all-cause, IBD-related, and non-IBD-related) were calculated using the prevalent Alberta IBD population. Hospitalizations were stratified by disease type, age, sex, and metropolitan status. Data were age and sex standardized to the 2019 Canadian population. Log-linear models calculated Average Annual Percentage Change (AAPC) in hospitalization rates with associated 95% confidence intervals (CIs).

Results: From 2002-2003 to 2018-2019, all-cause hospitalization rates decreased from 36.57 to 16.72 per 100 IBD patients (AAPC, -4.18%; 95% CI, -4.69 to -3.66). Inflammatory bowel disease-related hospitalization rate decreased from 26.44 to 9.24 per 100 IBD patients (AAPC, -5.54%; 95% CI, -6.19 to -4.88). Non-IBD-related hospitalization rate decreased from 10.13 to 7.48 per 100 IBD patients (AAPC, -1.82%; 95% CI, -2.14 to -1.49). Those over 80 years old had the greatest all-cause and non-IBD-related hospitalization rates. Temporal trends showing decreasing hospitalization rates were observed across age, sex, IBD type, and metropolitan status.

Conclusions: Hospitalization rates are decreasing for all-cause, IBD-related, and non-IBD-related hospitalizations. Over the past 20 years, the care of IBD has transitioned from hospital-based care to ambulatory-centric IBD management.

Keywords: Crohn’s disease; epidemiology; hospitalization rates; inflammatory bowel disease; ulcerative colitis.

Plain language summary

Hospitalization rates per 100 IBD patients are decreasing. However, when using the general population as the denominator, the interpretation of temporal trends changes because the prevalence of IBD has risen faster than the general population’s growth rate.

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Conflict of interest statement

G.K. has received honoraria for speaking or consultancy from AbbVie, Janssen, Pfizer, Amgen, and Takeda. He has received research support from Ferring, Janssen, AbbVie, GlaxoSmith Kline, Merck, and Shire. He has been a consultant for Gilead. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. September 7, 2018.

A-A.S. has research grants (investigator initiated programs) from Gilead and Intercept Pharmaceuticals.

H.S. has been on advisory boards or consulted to Pendopharm, Amgen Canada, Bristol Myers Squibb Canada, Roche Canada, Sandoz Canada, Takeda Canada, and Guardant Health, Inc.,

C.B. has consulted to or served on advisory boards for Abbvie Canada, Amgen Canada, Bristol Myers Squibb Canada, JAMP Pharmaceuticals, Janssen Canada, Pfizer Canada, Sandoz Canada, Takeda, and has received unrestricted educational grants from Abbvie Canada, Janssen Canada, Pfizer Canada, Bristol Myers Squibb Canada, and Takeda Canada. He has been on the speaker’s bureau of Abbvie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada. He has received research grants from Abbvie Canada, Amgen Canada, Pfizer Canada, and Sandoz Canada and contract grants from Janssen.

R.P. has received consulting fees from Abbott, AbbVie, Alimentiv (formerly Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, Eli Lilly, Ferring, Galapagos, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pendopharm, Pfizer, Progenity, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Takeda.

E.B. has acted as a legal consultant for Hoffman La-Roche Limited and Peabody & Arnold LLP.

A.O. has been on advisory boards of AbbVie Canada, Janssen Canada, and Nestle. He has received unrestricted educational grants from AbbVie Canada and Janssen Canada. His site is involved with clinical trials for AbbVie, Pfizer, Takeda, Eli Lily, and Celgene.

L.T. has received investigator initiated funding from Janssen Canada and served on advisory boards for AbbVie Canada, Sandoz Canada, Takeda Canada, Merck Canada, Pfizer Canada, Janssen Canada, and Roche Canada.

C.M. has received consulting fees from AbbVie, Alimentiv, Amgen, AVIR Pharma Inc, BioJAMP, Bristol Myers Squibb, Celltrion, Ferring, Fresenius Kabi, Janssen, McKesson, Mylan, Takeda, Pendopharm, Pfizer, Roche; speaker’s fees from AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Bristol Myers Squibb, Ferring, Fresenius Kabi, Janssen, Takeda, Pendopharm, and Pfizer; royalties from Springer Publishing; research support from Ferring, Pfizer.

A.B. has been a member of advisory boards for Abbvie, Pfizer, Takeda, Janssen, Merck and speaker’s bureau for Abbvie, Janssen, Takeda, Pfizer.

J.J. reports advisory board fees from AbbVie, Janssen, Pfizer, Ferring; speaker’s fees from AbbVie, Janssen Takeda; and research support from AbbVie, Janssen and Pfizer.

The following authors have no conflicts to declare: M.B., S.C., S.M., J. P., L.H., E.K., A.A-Z, and J.H-L.

Figures

**Figure 1.**
Age- and sex-standardized all-cause IBD hospitalization rates per 100 IBD patients stratified by age groups and disease type. The scale on the left refers to the summative bar graphs representing the distribution of disease type; the scale on the right refers to the line graphs representing the hospitalization rates by age group.

**Figure 2.**
Age- and sex-standardized IBD-related diagnosis IBD hospitalization rates per 100 IBD patients stratified by age groups and disease type. The scale on the left refers to the summative bar graphs representing the distribution of disease type; the scale on the right refers to the line graphs representing the hospitalization rates by age group.

**Figure 3.**
Age- and sex-standardized non-IBD-related diagnosis IBD hospitalization rates per 100 IBD patients stratified by age groups and disease type. The scale on the left refers to the summative bar graphs representing the distribution of disease type; the scale on the right refers to the line graphs representing the hospitalization rates by age group.

See this image and copyright information in PMC

References

1. Seyedian SS, Nokhostin F, Malamir MD.. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. NLM (Medline) 2019;12(2):113-122. - PMC - PubMed
1. Kaplan GG, Bernstein CN, Coward S, et al. The Impact of Inflammatory Bowel Disease in Canada 2018: Epidemiology. J Can Assoc Gastroenterol. 2019;2(Supplement_1):S6-S16. doi: 10.1093/jcag/gwy054 - DOI - PMC - PubMed
1. Nguyen GC, Targownik LE, Singh H, et al. The Impact of Inflammatory Bowel Disease in Canada 2018: IBD in Seniors. J Can Assoc Gastroenterol. 2019;2(Supplement_1):S68-S72. doi: 10.1093/jcag/gwy051 - DOI - PMC - PubMed
1. Buie MJ, Quan J, Windsor JW, et al. Global hospitalization trends for crohn’s disease and ulcerative colitis in the 21st century: a systematic review with temporal analyses. Clin Gastroenterol Hepatol. 2022. online ahead of print. doi: 10.1016/j.cgh.2022.06.030 - DOI - PubMed
1. Mao EJ, Hazlewood GS, Kaplan GG, Peyrin-Biroulet L, Ananthakrishnan AN.. Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn’s disease and ulcerative colitis. Aliment Pharmacol Ther. Jan 2017;45(1):3-13. doi: 10.1111/apt.13847 - DOI - PubMed

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Hospitalization Rates for Inflammatory Bowel Disease Are Decreasing Over Time: A Population-based Cohort Study

Affiliations

Hospitalization Rates for Inflammatory Bowel Disease Are Decreasing Over Time: A Population-based Cohort Study

Authors

Affiliations

Abstract

Plain language summary

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

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