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

Michael J Buie; Stephanie Coward; Abdel-Aziz Shaheen; Jayna Holroyd-Leduc; Lindsay Hracs; Christopher Ma; Remo Panaccione; Eric I Benchimol; Charles N Bernstein; Alain Bitton; Anthony R Otley; Jennifer L Jones; Sanjay K Murthy; M Ellen Kuenzig; Juan-Nicolás Peña-Sánchez; Laura E Targownik; Harminder Singh; Antonio Avina-Zubieta; Gilaad G Kaplan

doi:10.1093/ibd/izad020

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

Inflamm Bowel Dis. 2023 Oct 3;29(10):1536-1545. doi: 10.1093/ibd/izad020.

Authors

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.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged, 80 and over
Canada
Cohort Studies
Colitis, Ulcerative* / epidemiology
Delivery of Health Care
Hospitalization
Humans
Inflammatory Bowel Diseases* / epidemiology
Inflammatory Bowel Diseases* / therapy