Inflamm Bowel Dis. 2023 Oct 3;29(10):1536-1545. doi: 10.1093/ibd/izad020.

Michael J Buie ^1 2, Stephanie Coward ^1 2, Abdel-Aziz Shaheen ^1 2, Jayna Holroyd-Leduc ^1 2, Lindsay Hracs ^1 2, Christopher Ma ^1 3, Remo Panaccione ^2 3, Eric I Benchimol ^{4 5 6 7 8}, Charles N Bernstein ⁹, Alain Bitton ¹⁰, Anthony R Otley ¹¹, Jennifer L Jones ¹², Sanjay K Murthy ^{13 14 15 16}, M Ellen Kuenzig ^4 5, Juan-Nicolás Peña-Sánchez ¹⁷, Laura E Targownik ¹⁸, Harminder Singh ^19 20, Antonio Avina-Zubieta ²¹, Gilaad G Kaplan ^1 2

Author information

¹Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

²Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

³Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

⁴SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.

⁵Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.

⁶Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

⁷Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

⁸Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.

⁹Department of Medicine, and the University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

¹⁰Division of Gastroenterology and Hepatology, McGill University and McGill University Health Centre, Montreal, Quebec, Canada.

¹¹Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

¹²Division of Digestive Care & Endoscopy, Department of Medicine, Dalhousie University, Halifax, NS, Canada.

¹³Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

¹⁴Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.

¹⁵Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

¹⁶School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.

¹⁷Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

¹⁸Zane Cohen Centre for Digestive Diseases, Mount Sinai Health, Toronto, Ontario, Canada.

¹⁹Departments of Medicine and Community Health Sciences, University of Manitoba, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

²⁰Research Institute, CancerCare, Winnipeg, Manitoba, Canada.

²¹Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

Background: Recent advances in the management of inflammatory bowel disease (IBD) striving for new treatment targets may have decreased rates of hospitalization for flares. We compared all-cause, IBD-related, and non-IBD-related hospitalizations while accounting for the rising prevalence of IBD.

Methods: Population-based, administrative health care databases identified all individuals living with IBD in Alberta between fiscal year 2002 and 2018. Hospitalization rates (all-cause, IBD-related, and non-IBD-related) were calculated using the prevalent Alberta IBD population. Hospitalizations were stratified by disease type, age, sex, and metropolitan status. Data were age and sex standardized to the 2019 Canadian population. Log-linear models calculated Average Annual Percentage Change (AAPC) in hospitalization rates with associated 95% confidence intervals (CIs).

Results: From 2002-2003 to 2018-2019, all-cause hospitalization rates decreased from 36.57 to 16.72 per 100 IBD patients (AAPC, -4.18%; 95% CI, -4.69 to -3.66). Inflammatory bowel disease-related hospitalization rate decreased from 26.44 to 9.24 per 100 IBD patients (AAPC, -5.54%; 95% CI, -6.19 to -4.88). Non-IBD-related hospitalization rate decreased from 10.13 to 7.48 per 100 IBD patients (AAPC, -1.82%; 95% CI, -2.14 to -1.49). Those over 80 years old had the greatest all-cause and non-IBD-related hospitalization rates. Temporal trends showing decreasing hospitalization rates were observed across age, sex, IBD type, and metropolitan status.

Conclusions: Hospitalization rates are decreasing for all-cause, IBD-related, and non-IBD-related hospitalizations. Over the past 20 years, the care of IBD has transitioned from hospital-based care to ambulatory-centric IBD management.