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IBD prevalence, disease burden, cost on the rise
The cascade of chronic immune and inflammatory responses that fall under the heading of inflammatory bowel diseases has become increasingly common, and increasingly costly, in the United States.
According to the CDC, the disease burden of IBD as a chronic condition is among the top five in gastrointestinal diseases, and represents an overall health care cost of more than $1.7 billion.
As a chronic condition with no medical cure, IBD is the cause of 700,000 doctor visits, 100,000 hospitalizations and 119,000 patients who are disabled by the condition, the CDC reported. Over the lifetime of care generally needed for patients with IBD, surgery will eventually be required for as many as 75% of patients with Crohn’s disease and 25% of those with ulcerative colitis.
With these alarming statistics in mind, it is cause for concern that the burden and prevalence of IBD continues to increase in the United States, according to a 2013 study by Michael D. Kappelman, MD, MPH, of University of North Carolina at Chapel Hill, and colleagues.
“The results of our study, using insurance claims data, suggest that nearly 1.2 million Americans are living with IBD,” they wrote.
IBD in the US
Kappelman and colleagues used claims data from roughly 12 million Americans to conduct three consecutive, 2-year, cross sectional studies evaluating cases of CD and UC. The three analyses were conducted between 2004-2005, 2006-2007 and 2008-2009.
The researchers estimated prevalence of these conditions by dividing cases by the number of individuals in the source population. The incidence of these conditions was compared by region, age and gender using logistic regression.
According to data, in 2009, the most recent year evaluated, the prevalence of CD in children was 58 per 100,000 in the insured population. The prevalence of UC in children was 34 per 100,000 in the population. In adults, CD prevalence was 241 per 100,000, and UC prevalence was 263 per 100,000 individuals in the population.
Prevalence by gender, age, region
Researchers reported a higher prevalence of both CD and UC associated with older age, although CD prevalence did not change significantly between the ages of 30 and 50 years. Additionally, pediatric CD was more common in boys than in girls (OR=0.88; 95% CI, 0.81-0.97), with this trend reversing in the adult population. There were no gender-based prevalence differences in UC in adults or children.
Differences in IBD prevalence were also noted based on US geographic region. For both UC and CD, the prevalence was higher in the Northeast and Midwest vs. the South and West. The exception the researchers noted was pediatric UC, which showed an increased prevalence only in the Northeast region of the US.
When analyzed based on time periods, the researchers found the prevalence of both CD and UC increased slightly in both children and adults between 2004-2005 and 2008-2009 (P<.001).
“The burden of IBD in the USA continues to increase, owing largely to the continued steady increase in prevalence for these chronic conditions,” the researchers wrote. “This up-to-date epidemiological data may be used to support disease surveillance and inform policy, including anticipating the need for clinical services by this patient population, establishing research priorities, and supporting IBD advocacy efforts.”
For more information:
Kappelman MD. Dig Dis Sci. 2013;58:519-525.
Disclosures: The researchers report no relevant financial disclosures.