This article is more than 5 years old. Information may no longer be current.
CDC: Hospitalizations for Crohn's disease remain stable
Hospitalizations in the U.S. for an initial diagnosis of Crohn’s disease remained stable between 2003 and 2013, suggesting the increasing rate estimated in the prior decade may have plateaued, according to a report from the CDC.
However, hospitalizations for any-listed diagnosis of Crohn’s disease — meaning that Crohn’s was not necessarily the main reason for hospitalization — increased during this period, and while the rate of inpatient small bowel resections performed during hospitalizations for a first-listed diagnosis dropped, colorectal resection and fistula repair rates remained stable.
“Stable trends for a first-listed Crohn’s disease diagnosis from 2003 to 2013 suggest that the 4.3% annual increase reported for a first-listed diagnosis from 1998 to 2004 has not continued,” investigators wrote. “Although this result suggests that the available treatments have not increased clinical remissions or reduced hospitalizations, it is possible that these trends indicate the beginning of a reversal of the increased hospitalizations and surgical procedures observed in the years leading up to the study period.”
Further, they added that “the declines in small bowel resection during hospitalizations might represent a decrease in clinical severity, possibly related to newer therapies,” and the continually increasing hospitalization rate for any-listed Crohn’s diagnosis “might represent greater physician awareness and diagnosis of Crohn’s disease or more complete coding of secondary diagnoses by physicians.”
To estimate hospitalizations for Crohn’s disease as first- and any-listed discharge diagnoses, and also common surgical procedures performed during hospitalizations as first-listed diagnoses, CDC investigators reviewed hospital discharge data from the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2003 to 2013.
Overall hospitalizations for first-listed Crohn’s diagnoses did not change significantly, increasing from 52,855 (18.2 per 100,000) to 60,255 (19.1 per 100,000), a relative increase of 5.2%.
However, while age-adjusted hospitalization rates were higher among females for both first- and any-listed diagnoses (P < .05), hospitalizations for first-listed diagnoses only increased significantly among males, from 21,931 (15.4 per 100,000) to 27,330 (17.6 per 100,000), a relative increase of 14.5%.
Hospitalizations for first-listed diagnoses were also higher among patients aged 18 to 44 years compared with other age groups in both 2003 and 2013, while hospitalizations for any-listed diagnoses “increased among successive age groups until ages 65-84 years,” investigators wrote.
The percentage of hospitalizations during which small bowel resection was performed dropped from 4.9% to 3.9% (P < .05), but colorectal resection (14.8% vs. 12.8%) and fistula repair rates (1.8% vs. 2%) did not change significantly.
Hospitalizations for any-listed Crohn’s disease diagnosis increased from 120,209 (44.2 per 100,000) to 196,480 (59.7 per 100,000), a relative increase of 35.1% (P < .05). The investigators noted they observed geographic variations in hospitalizations for any-listed Crohn’s disease, with the lowest rates “clustered in the Southwest and Rocky Mountain states.”
While determining changes to public health practice that could help prevent Crohn’s disease is difficult because its cause is unknown, “patient education initiatives could focus on increasing awareness of exacerbating factors such as cigarette smoking and stress, and medication compliance to prevent hospitalizations,” the report concludes. “Professional education should continue to increase awareness of the signs and symptoms of Crohn’s disease and improve diagnosis and management.” – by Adam Leitenberger
Disclosures: Healio Gastroenterology was unable to confirm the researchers’ relevant financial disclosures at the time of publication.