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National Trends in Hospitalization, Surgical Resection, and Comorbidities in Pediatric Inflammatory Bowel Disease in the United States, 2002-2015

Authors
  • Ihekweazu, Faith D.1, 2
  • Dongarwar, Deepa2
  • Salihu, Hamisu M.2, 3
  • Kellermayer, Richard1, 4
  • 1 Department of Pediatric Gastroenterology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, 77030, USA
  • 2 Baylor College of Medicine Center of Excellence in Health Equity, Training and Research, Houston, TX 77021, USA
  • 3 Department of Family Medicine, Baylor College of Medicine, Houston, TX, 77098, USA
  • 4 USDA/ARS Children’s Nutrition Research Center, Houston, TX, 77030, USA
Type
Published Article
Journal
International Journal of Maternal and Child Health and AIDS
Publisher
Global Health and Education Projects, Inc
Publication Date
Mar 06, 2022
Volume
11
Issue
1
Identifiers
DOI: 10.21106/ijma.522
PMID: 35601678
PMCID: PMC8907895
Source
PubMed Central
Keywords
Disciplines
  • Original Article | Inflammatory Bowel Disease
License
Unknown

Abstract

Background and Objective: Therapeutic options for pediatric inflammatory bowel disease (PIBD) have dramatically changed over the last 20 years. However, the impact of modern medical management on PIBD outcomes remains unclear. We aimed to fill this gap in the literature by using a large, validated, national database, to study the change in hospitalization rates, surgical rates, and postoperative complications in PIBD over the last decade. Methods: The National Inpatient Sample (NIS) Database and ICD-9-CM codes were utilized to identify inpatient admissions with a primary or secondary diagnosis of pediatric Crohn’s disease (CD) or ulcerative colitis (UC) from 2002-2015. Trends in hospitalizations, comorbidities (including malnutrition and weight loss), surgical procedures, and postoperative complications were examined using joinpoint regression analysis, a statistical modeling approach to evaluate the extent to which the rate of a condition changes over time. Results: There were 119,282 admissions for PIBD during the study period. The annual incidence of hospitalization increased significantly over time for both CD (average annual percent change [AAPC] 6.0%) and UC (AAPC 7.2%). The rate of intestinal resection decreased in CD patients (AAPC -6.4%) while postoperative complications remained unchanged. However, comorbidities increased significantly in CD patients (AAPC 6.8%). For pediatric UC patients, postoperative complications (AAPC 6.7%), and comorbidities (AAPC 10.2%) increased significantly over time while intestinal resection rates remained stable. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Conclusion and Global Health Implications: Annual incidence of hospitalization and comorbidities continue to increase in PIBD. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Our findings emphasize the critical need for prevention and novel therapeutic options for this vulnerable patient population.

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