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Gastroenterology. 2014 Oct;147(4):803-813.e7; quiz e14-5. doi: 10.1053/j.gastro.2014.06.023. Epub 2014 Jun 18.

Incidence, outcomes, and health services burden of very early onset inflammatory bowel disease.

Author information

1
Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada. Electronic address: ebenchimol@cheo.on.ca.
2
Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Canada.
3
Institute for Clinical Evaluative Sciences, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Mount Sinai Centre for Inflammatory Bowel Disease, Toronto, Canada.
4
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Boston, Boston, Massachusetts; Department of Medicine, Harvard University, Boston, Massachusetts.
5
Institute for Clinical Evaluative Sciences, Toronto, Canada.
6
Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
7
Department of Paediatrics, University of Toronto, Toronto, Canada; SickKids Inflammatory Bowel Disease Center, Division of Gastroenterology Hepatology and Nutrition, Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.

Abstract

BACKGROUND & AIMS:

The Paris pediatric modification of the Montreal classification defines very early onset inflammatory bowel disease (VEO-IBD) as a form of IBD distinct from that of older children. We compared the incidence and outcomes of VEO-IBD with those of IBD in older children.

METHODS:

We performed a population-based retrospective cohort study of all children diagnosed with IBD in Ontario, Canada, from 1994 through 2009. Trends in standardized incidence were calculated using Poisson regression. We compared outpatient and emergency department visits, hospitalizations, and surgeries among children diagnosed with IBD when they were younger than age 6, ages 6-9.9, and older than age 10 years. Multivariable models were adjusted for income and stratified by sex.

RESULTS:

The incidence of IBD increased from 9.4 per 100,000 children (95% confidence interval [CI], 8.2-10.8/100,000 children) in 1994 to 13.2 per 100,000 children (95% CI, 11.9-14.6/100,000 children) in 2009 (P < .0001). The incidence increased by 7.4% per year among children younger than 6 years old and 6-9.9 years old, and by 2.2% per year among children ≥10 years old. IBD-related outpatient visits were less frequent among children <6 years old than ≥10 years old (odds ratio for female patients, 0.67; 95% CI, 0.58-0.78; odds ratio for male patients, 0.86; 95% CI, 0.75-0.98). Hazard ratios [HRs] for hospitalization were lower for children <6 years old (female HR, 0.70; 95% CI, 0.56-0.87; male HR, 1.12; 95% CI, 0.94-1.33) than for older children. HRs for surgery among children <6 years old with Crohn's disease were 0.35 for female patients (95% CI, 0.16-0.78) and 0.59 for male patients (95% CI, 0.34-0.99). HRs for children <6 years old with ulcerative colitis were 0.88 for female patients (95% CI, 0.47-1.63) and 0.42 for male patients (95% CI, 0.21-0.85). There was no difference in hospitalization or surgery rates among children 6-9.9 years old vs those ≥10 years old.

CONCLUSIONS:

Based on a retrospective cohort study, the incidence of VEO-IBD increased from 1994 through 2009. Children diagnosed with IBD before they were 6 years old used fewer health services and had lower rates of surgery than children diagnosed when they were 10 years or older.

KEYWORDS:

Disease Progression; Epidemiology; Health Administrative Data; Pediatrics

PMID:
24951840
DOI:
10.1053/j.gastro.2014.06.023
[Indexed for MEDLINE]

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