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Newly industrialized nations see rise in IBD hospitalization

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ORLANDO — From 1990 to 2015, the rate of hospitalizations for IBD across industrialized countries of the Western world appeared to stabilize or decrease. However, rates significantly increased for many of the newly industrialized countries across Asia and South America, according to research presented at the World Congress of Gastroenterology at ACG 2017.

“We know that the prevalence and incidence of IBD has been increasing in the world ever since the industrial revolution. However, we also began to see an increase in newly industrialized countries near the end of the 20th century, and because of this, we can now understand IBD to be a global disease. It is therefore worth investigating how these patterns may affect health care utilization among patients residing in different regions of the world,” James A. King, BA, of the University of Calgary, said during his presentation.

The researchers sought to assess the differences in hospitalization rates for IBD across 34 countries belonging to the Organization of Economic Co-operation and Development (OECD) between 1990 and 2015. The OECD is designed to develop policy solutions related to the economic and social well-being of citizens throughout the world.

For this study, researchers calculated hospitalization rates as annual rates per 100,000 persons. They calculated the average annual percent change in the rate of hospitalization for each country between 1990 and 2015 with join point regression models, and choropleth maps displayed the differences in hospitalization rates and average annual percent change. The researchers additionally standardized hospital discharge rates from 2010 to 2014 to allow for comparison between countries.

Sufficient longitudinal data were provided by 32 countries included in the OECD.

According to study data, the median hospitalization rate was 31.2 (interquartile range, 23.7 to 47.4 per 100,000 persons). Between 2010 and 2014, hospitalization rates were highest across North America (U.S., 33.9 per 100,000), Northern Europe (Denmark, 63.6 per 100,000), Eastern Europe (Hungary, 50.4 per 100,000), Western Europe (Austria, 73 per 100,000) and Oceania (Australia, 31.2 per 100,000).

However, half of all countries across Europe, Northern America and Oceania showed decreasing or stable hospitalization rates, whereas countries in Asia and Southern America showed the lowest hospitalization rates and the highest increase in average annual percent change, according to King.

For example, the average hospitalization rate in Turkey was 10 per 100,000 persons with an average annual percent change of 9.2% (95% CI, 5.9-12.5) and the average hospitalization rate in Chile was 8.4 per 100,000 with an average annual percent change of 5.2% (95% CI, 4.3-6.2).

King noted several limitations of the study, including that Crohn’s disease and ulcerative colitis could not be stratified; country data were not available for each year between 1990 and 2015; there were variations in definitions, sources and methods used for hospital discharges; and medical admissions could not be differentiated from surgical admissions.

“Despite these limitations, there are key overall trends that we can look at from this research,” he said. “Hospital discharge rates for IBD are quite high and while these rates are either stable or decreasing in some countries, they are increasing in some areas of the newer industrialized world. When trying to interpret and understand this data, it is quite complex and multi-faceted, but one potential explanation is the epidemiology of IBD — we can see that trends are reflecting the trends in incidence and prevalence in IBD. Other potential explanations for this is the differential health care resources and there are some societal factors at play.”

Reference: King JA, et al. Abstract 15. Presented at: World Congress of Gastroenterology at American College of Gastroenterology Annual Scientific Meeting; Oct. 13-18, 2017; Orlando, FL.

Disclosure: King reports no relevant financial disclosures.