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'Opposing trends' identified in prevalence of diverticulitis, diverticular bleeding
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Researchers have identified differing trends in the prevalence of hospitalizations for diverticulitis and diverticular bleeding in the U.S. overall, and according to sex and race.
Similar studies have focused primarily on diverticulitis or a composite of diverticulitis and diverticular bleeding, and understanding of the effects of sex and race on diverticular disease is limited. Researchers therefore evaluated prevalence estimates of hospitalizations for diverticulitis and diverticular bleeding using data from the Nationwide Inpatient Sample from 2000 to 2010 to compare overall trends in prevalence as well as age-, sex- and race-specific prevalence rates.
“Understanding recent trends in the prevalence of diverticulitis and diverticular bleeding could help predict the impact of these disorders on the health care system and public health, and shed light on potential risk factors,” they wrote.
There were 2,151,023 hospitalizations for diverticulitis over the study period, mostly in patients aged 40 and older (mean per year, 195,548 ± 22,418; 58% women; 82% white), and 780,414 hospitalizations for diverticular bleeding (mean per year, 70,947 ± 5,638; 54% women; 74% white; 46% aged older than 80 years).
They found that the prevalence of hospitalizations for diverticulitis was 74.1 per 100,000 persons in 2000, peaked at 96 in 2008, and plateaued at 91.9 in 2010. Conversely, the prevalence of diverticular bleeding decreased from 32.5 to 27.1 per 100,000 persons throughout the same period.
“The absolute prevalence difference per 100,000 for diverticular bleeding … was 5.4 (95% CI, – 5.1 to – 5.7),” the researchers wrote. “For diverticulitis, it was 17.8 (95% CI, 17.3-18.3).”
Furthermore, the prevalence of diverticulitis was found to be increased in women compared with men (98.6 vs. 76.3 per 100,000), while rates of diverticular bleeding were comparable between men and women. Finally, the highest prevalence of diverticular bleeding occurred in blacks (27.3 per 100,000), while the highest prevalence of diverticulitis occurred in whites (61.8 per 100,000).
“These data indicate that the impact these disorders have on the hospital system may be stabilizing after a precipitous climb in the prior century,” the researchers concluded. “Differences in age-, race-, and sex-specific prevalence for diverticulitis and diverticular bleeding suggest that these complications may have different etiopathogenic mechanisms.”
“The etiology of these trends is unknown, although changing environmental factors (diet; physical activity; and use of medications, such as nonsteroidal anti-inflammatory drugs) may play a role,” Marc S. Piper, MD, and Sameer D. Saini, MD, MS, from the University of Michigan Medical School, wrote in a related editorial. “Alternatively, it is possible that the increased prevalence reflects ‘case finding,’ increased detection if disease related to changes in clinical practice, such as growing use of cross-sectional imaging.” Commenting on this and a related study of the management of recurrent diverticulitis, they concluded that “the epidemiology and management of diverticular disease is undergoing a renaissance,” which will provide “an opportunity to deliver more patient-centered care.” – by Adam Leitenberger
Disclosures: The researchers, Piper and Saini report no relevant financial disclosures.
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