Global Hospitalization Trends for Crohn's Disease and Ulcerative Colitis in the 21 st Century: A Systematic Review with Temporal Analyses

Clin Gastroenterol Hepatol. 2022 Jul 18;S1542-3565(22)00670-X.doi: 10.1016/j.cgh.2022.06.030. Online ahead of print.


Michael J Buie 1Joshua Quan BKin 2Joseph W Windsor 1Stephanie Coward 1Tawnya M Hansen 3James A King 4Paulo G Kotze 5Richard B Gearry 6Siew C Ng 7Joyce Wy Mak 7Maria T Abreu 8David T Rubin 9Charles N Bernstein 10Rupa Banerjee 11Jesus K Yamamoto-Furusho 12Remo Panaccione 13Cynthia H Seow 1Christopher Ma 13Fox E Underwood 1Vineet Ahuja 14Nicola Panaccione 13Abdel-Aziz Shaheen 1Jayna Holroyd-Leduc 1Gilaad G Kaplan 15GIVES-21 Consortia



GIVES-21 Consortia: 

Domingo Balderramo 16Vui Heng Chong 17Fabián Juliao-Baños 18Usha Dutta 19Marcellus Simadibrata 20Jamilya Kaibullayeva 21Yang Sun 22Ida Hilmi 23Raja Affendi Raja Ali 24Mukesh Sharma Paudel 25Mansour Altuwaijri 26Juanda Leo Hartono 27Shu Chen Wei 28Julajak Limsrivilai 29Sara El Ouali 30Beatriz Iade Vergara 31Viet Hang Dao 32Paul Kelly 33Phoebe Hodges 33Yinglei Miao 22Maojuan Li 22


Author information

1Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary.

2Department of Community Health Sciences, University of Calgary.

3Section of Gastroenterology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg.

4Centre for Health Informatics, University of Calgary; Alberta Strategy for Patient Oriented Research Support Unit Data Platform and Provincial Research Data Services, Alberta Health Services.

5IBD outpatient clinics, Catholic University of Paraná, Curitiba, Brazil.

6Department of Medicine, University of Otago, Christchurch, New Zealand.

7Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.

8Department of Medicine and Microbiology and Immunology, University of Miami.

9Inflammatory Bowel Disease Center, University of Chicago, Chicago, USA.

10University of Manitoba IBD Clinical and Research Centre and Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

11IBD Center, Asian Institute of Gastroenterology, Hyderabad, India.

12Inflammatory Bowel Disease Clinic, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition and National Autonomous University of Mexico (UNAM), Mexico City, Mexico.

13Department of Medicine, University of Calgary.

14Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

15Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary. Electronic address: ggkaplan@ucalgary.ca.

16Gastroenterology Department, Hospital Privado Universitario de Córdoba.

17Division of Gastroenterology and Hepatology, Department of Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei Darussalam.

18Department of Gastroenterology, Pablo Tobon Uribe Hospital, Medellín, Colombia.

19Department of Gastroenterology, Postgraduate Institute of Medical education and Research, Chandigarh, India.

20Division of Gastroenterology, Department Internal Medicine, Faculty Medicine, Dr. Cipto Mangunkusumo Hospital Indonesia, Universitas Indonesia.

21Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.

22Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases.

23Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

24Gastroenterology Unit and GUT Research Group, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

25Department of Gastrointestinal, National Academy of Medical Sciences, Kathmandu, Nepal.

26Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

27Yong Loo Lin School of Medicine, National University of Singapore. Division Gastroenterology & Hepatology, National University Hospital, Singapore.

28Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.

29Division of Gastroenterology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

30Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.

31Centro de Asistencia del Sindicato Médico del Uruguay (CASMU) Cooperativa de Servicios Médicos (COSEM), Uruguay.

32Internal Medicine, Hanoi Medical University, Vietnam.

33Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London; Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine.


Background and aims: The evolving epidemiologic patterns of inflammatory bowel disease (IBD) throughout the world, in conjunction with advances in therapeutic treatments, may influence hospitalization rates of IBD. We performed a systematic review with temporal analysis of hospitalization rates for IBD across the world in the 21st century.

Methods: We systematically reviewed Medline and Embase for population-based studies reporting hospitalization rates for IBD, Crohn's disease (CD), or ulcerative colitis (UC) in the 21st century. Log-linear models were used to calculate average annual percentage change (AAPC) with associated 95% confidence intervals (CI). Random effects meta-analysis pooled country level AAPCs. Data were stratified by the epidemiologic stage of a region: Compounding Prevalence (Stage 3) in North America, Western Europe, and Oceania versus Acceleration of Incidence (Stage 2) in Asia, Eastern Europe, and Latin America versus Emergence (Stage 1) in developing countries.

Results: Hospitalization rates for a primary diagnosis of IBD were stable in countries in Stage 3 (AAPC=-0.13%; 95% CI: -0.72, 0.97), CD (AAPC=0.20%; 95% CI: -1.78, 2.17), and UC (AAPC=0.02%; 95% CI: -0.91, 0.94). In contrast, hospitalization rates for a primary diagnosis were increasing in countries in Stage 2 for IBD (AAPC=4.44%; 95% CI: 2.75, 6.14), CD (AAPC=8.34%; 95% CI: 4.38, 12.29), and UC (AAPC=3.90; 95% CI: 1.29, 6.52). No population-based studies were available for developing regions in Stage 1 (Emergence).

Conclusion: Hospitalization rates for IBD are stabilizing in countries in Stage 3, whereas newly industrialized countries in Stage 2 have rapidly rising hospitalization rates, contributing to an increasing burden on global healthcare systems.



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