World Congress at ACG2017

Simultaneous Plenary Session 1B: IBD

15 - Paradoxical Trends in Hospitalization Rates for the Inflammatory Bowel Diseases Between the Western World and Newly Industrialized Countries: A Study of the Organization for Economic Cooperation and Development (OECD)

Monday, October 16
4:40 PM - 4:50 PM
Location: Valencia Ballroom BC (Level 4)



Category: IBD       

James A. King, BA1, Fox Underwood, MSc1, Nicola Panaccione1, Josh Quan1, Paulo Kotze, MD, PhD 2, Siew C. Ng, MBBS, PhD3, Subrata Ghosh, MD4, Peter L. Lakatos, MD 5, Tine Jess, MD6, Remo Panaccione, MD, FRCP7, Gilaad Kaplan, MD, MPH 1
1University of Calgary, Calgary, AB, Canada; 2Cajuru Hospital, Curitiba, Parana, Brazil; 3Chinese University of Hong Kong, Shatin, Hong Kong; 4Institute of Translational Medicine, Birmingham, United Kingdom; 5McGill University, Montreal, PQ, Canada; 6Statens Serum Institut, Copenhagen, Hovedstaden, Denmark; 7University of Calgary, Department of Medicine, Calgary, AB, Canada
Introduction: Hospitalization rates for the inflammatory bowel diseases (IBD) may be decreasing in the Western world due to advances in medical management. In contrast, newly industrialized countries in Asia and Southern America may have increasing hospitalization rates due to rapidly rising incidence. We evaluated changing rates in hospitalization for IBD in countries belonging to the Organisation for Economic Co-operation and Development (OECD).

Methods: The OECD database contained IBD related hospital discharges for 34 countries from 1990 to 2015. Hospitalization rates were expressed as annual rates per 100,000 persons. Average hospitalization rates were standardized for the period 2010 to 2014. Joinpoint regression models were used to calculate the average annual percent change (AAPC) in the rate of hospitalization for each country in 1990 to 2015. Choropleth maps were created to display the differences in hospitalization rates and AAPCs.

Results: Hospitalization rates related to IBD from OECD countries are presented in Table 1 and Figure 1. The median hospitalization rate was 31.2 with an interquartile range (IQR) of 23.7 to 47.4 per 100,000. Average hospitalization rates from 2010 to 2014 were highest in Northern America (e.g. US: 33.9 per 100,000), Northern Europe (e.g. Denmark: 63.6 per 100,000), Eastern Europe (e.g. Hungary: 50.4 per 100,000), Western Europe (e.g. Austria: 73.0 per 100,000), and Oceania (e.g. Australia: 31.2 per 100,000). In Europe, Northern America, and Oceania, 50% of countries have decreasing or stable hospitalization rates (Table 1, Figure 1–3). In contrast, countries from Asia and Southern America have the lowest hospitalization rates, yet the highest rise in AAPC. For example, Turkey has a hospitalization rate of 10.0 per 100,000 and an AAPC of 9.2% (95% CI: 5.9, 12.5), while Chile has a hospitalization rate of 8.4 per 100,000 and an AAPC of 5.2% (95% CI: 4.3, 6.2) (Table 1, Figure 1–3).

Discussion: Highly industrialized countries of the Western world have high rates of hospitalization; however, the rate of hospitalization appears to be stabilizing or decreasing in many Western countries. In contrast, newly industrialized countries in Asia and Southern America have rapidly rising hospitalization rates, which parallel the known rise in incidence of IBD outside the Western world.

Supported by Industry Grant: No


Table 1: Trends in hospital discharges for Crohn’s disease and ulcerative colitis in OECD countries.



































































































































































































































































































UN Region Country Discharge Rate (2010-2014) AAPC (95% CI) AAPC Time Period AAPC (95% CI) by Joinpoint Segment AAPC Segment Time Period
Northern Europe Denmark 63.6 -1.1* (-2.1, -0.0) 2001-2015 (1) 0.9 (-0.1, 2.0)
(2) -4.6* (-7.1, -2.0)
(1) 2001-2010
(2) 2010-2015
Finland 54.8 -1.1* (-1.8, -0.4) 2001-2014 (1) -0.5* (-1.0, -0.1)
(2) -2.9 (-5.8, 0.2)
(1) 2001-2011
(2) 2011-2014
Iceland 35.6 -4.9* (-9.4, -0.2) 2000-2014 (1) 10.5* (2.4, 19.1)
(2) -18.1* (-24.7, -11.0)
(1) 2000-2007
(2) 2007-2014
Ireland 43.6 0.7 (-0.0, 1.3) 1995-2014 (1) 3.7* (2.0, 5.4)
(2) -1.1* (-1.7, -0.4)
(1) 1995-2002
(2) 2002-2014
Latvia^ 18.7           - 2013-2015                     -                   - 
Lithuania^± 26.3           - 2013-2014                     -                  - 
Norway 59.5 -1.0 (-2.2, 0.2) 2000-2014 (1) 4.1 (-0.0, 8.5)
(2) -3.0* (-3.9, -2.0)
(1) 2000-2004
(2) 2004-2014
Sweden 51.9 -2.3* (-4.0, -0.6) 2000-2014 (1) -1.2* (-1.7, -0.7)
(2) -4.9 (-11.3, 1.9)
(1) 2000-2010
(2) 2010-2014
United Kingdom 40.0 1.1* (0.8, 1.4) 2000-2014 No inner segments.                -
Southern Europe Italy 28.1 -0.8* (-1.2, -0.4) 2001-2014 (1) 1.2* (0.3, 2.2)
(2) -2.0* (-2.5, -1.6)
(1) 2001-2006
(2) 2006-2014
Portugal 16.7 8.1* (6.4, 9.8) 1995-2014 (1) 22.6* (16.7, 28.7)
(2) 2.0* (1.0, 3.1)
(1) 1995-2001
(2) 2001-2014
Slovenia 35.3 1.2* (0.5, 1.8) 1997-2014 No inner segments.               -
Spain 23.7 5.5* (4.7, 6.3) 1990-2014 (1) 12.0* (10.3, 13.8)
(2) 0.3 (-0.4, 1.1)
(1) 1990-2001
(2) 2001-2014
Eastern Europe Czech Republic 47.4 2.7* (1.9, 3.5) 2000-2014 (1) 6.5* (3.5, 9.4)
(2) 1.2* (0.6, 1.8)
(1) 2000-2004
(2) 2004-2014
Hungary 50.4 -3.6* (-5.0, -2.2) 2004-2014 No inner segments.              -
Poland 37.3 6.8* (5.9, 7.8) 2003-2014 No inner segments.              -
Slovak Republic 23.7 0.1 (-1.4, 1.6) 2000-2014 No inner segments.              -
Western Europe Austria 73.0 2.2* (1.7, 2.6) 1990-2014 (1) 4.3* (3.2, 5.4)
(2) 0.9* (0.5, 1.4)
(1) 1990-1999
(2) 1999-2014
Belgium 32.6 -0.6* (-1.0, -0.2) 2000-2013 No inner segments.              -
France 27.0 -0.1 (-0.3, 0.1) 1997-2014 No inner segments.              -
Germany 57.9 2.2* (1.7, 2.6) 2000-2014 No inner segments.              -
Luxembourg 33.7 -2.0* (-3.3, -0.6) 1998-2014 No inner segments.              -
Netherlands 32.0 1.7* (1.2, 2.2) 1990-2012 (1) -0.1 (-1.0, 0.8)
(2) 3.3* (2.7, 3.9)
(1) 1990-2000
(2) 2000-2012
Switzerland 21.3 0.7 (-0.1, 1.4) 2002-2014 No inner segments.              -
Americas Canada 30.9 -1.7* (-1.9, -1.4) 1990-2013 (1) -0.2 (-0.7, 0.3)
(2) -2.4* (-2.6, -2.2)
(1) 1990-1998
(2) 1998-2013
Chile 8.4 5.2* (4.3, 6.2) 2001-2013 (1) 3.7* (2.9, 4.5)
(2) 9.9* (6.2, 13.7)
(1) 2001-2010
(2) 2010-2013
Mexico 1.6 3.7* (2.5, 5.0) 1995-2014 (1) 2.3* (1.1, 3.6)
(2) 6.8* (3.5, 10.1)
(1) 1995-2008
(2) 2008-2014
United States 33.9 2.3* (1.9, 2.7) 1990-2010 No inner segments.              -
Asia Israel 27.0 2.0 (-0.2, 4.3) 2000-2014 (1) 5.2* (1.2, 9.2)
(2) -1.0 (-4.2, 2.3)
(1) 2000-2007
(2) 2007-2014
Japan 26.8 3.8* (2.3, 5.4) 1993-2014 No inner segments.              -
South Korea 14.7 4.9* (4.4, 5.3) 1996-2014 (1) 2.6* (1.6, 3.6)
(2) 7.2* (6.6, 7.8)
(1) 1996-2005
(2) 2005-2014
Turkey 10.0 9.2* (5.9, 12.5) 2007-2014 No inner segments.              -
Oceania Australia 31.2 1.2* (1.0, 1.4) 1993-2013 No inner segments.              -
New Zealand 25.9 1.6* (1.0, 2.3) 2000-2013 No inner segments.              -


*AAPC is statistically significant (p ≤ 0.05). Note: Non-significance denotes stable hospitalization rates.
^Less than 5 years of data were available, so an AAPC could not be calculated.
±This is a non-OECD country.

Hospital discharges were measured per 100,000 individuals.

Figure 1: Global map of the average hospitalization rates for IBD from 2010 to 2014 in 34 Organization for Economic Co-Operation and Development countries, stratified by quartile.
Figure 2: Global map of the average annual percent change in hospitalization rates for IBD in 32 Organization for Economic Co-Operation and Development countries from time periods ranging between 1990 and 2015, stratified by quartile.

Citation: . PARADOXICAL TRENDS IN HOSPITALIZATION RATES FOR THE INFLAMMATORY BOWEL DISEASES BETWEEN THE WESTERN WORLD AND NEWLY INDUSTRIALIZED COUNTRIES: A STUDY OF THE ORGANIZATION FOR ECONOMIC COOPERATION AND DEVELOPMENT (OECD). Program No. 15. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

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