J Crohns Colitis. 2024 Aug 14;18(8):1241-1249.doi: 10.1093/ecco-jcc/jjae029.

Ohad Atia ¹, Nicklas Bryder ², Adi Mendelovici ¹, Natan Ledderman ³, Amir Ben-Tov ^4 5, Mehdi Osooli ², Anders Forss ², Yiska Loewenberg Weisband ⁶, Eran Matz ⁷, Iris Dotan ^5 8, Dan Turner ¹, Ola Olén ^2 9

Author information

¹Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.

²Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

³Meuhedet Health Services, Tel-Aviv, Israel.

⁴Kahn-Sagol-Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.

⁵Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.

⁶Clalit Health Services, Clalit Research Institute, Tel-Aviv, Israel.

⁷Leumit Health Services, Tel-Aviv, Israel.

⁸Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.

⁹Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden.

Abstract

Background: We aimed to explore the epidemiology of inflammatory bowel diseases [IBD] in association with the COVID-19 pandemic in two countries with different lockdown policies.

Methods: We utilized nationwide IBD cohorts in Israel and Sweden to explore the incidence of IBD during the pandemic compared to 3 years prior [2017-2019]. We examined temporal trends through the presence of inflection points by Joinpoint regression analysis and reported average monthly percentage changes [AMPC].

Results: A total of 155 837 patients with IBD were included [Israel, 58 640; Sweden, 97 197]. The annual incidence of IBD was stable until 2019 in both countries but then decreased in Israel (AAPC -16.6% [95% confidence interval, CI, -19.9% to -10.0%]) and remained stable in Sweden (AAPC -3.5% [95% CI -11.6% to 3.7%]). When exploring the monthly incidence during the pandemic, in Israel the rate remained stable until November 2020 (AMPC 2.3% [95% CI -13.4% to 29.9%]) and then decreased sharply (AMPC -6.4% [95% CI -20.8% to 17.0%] until February 2021 and to -20.1% [95% CI -38.9% to -4.7%] from February 2021), while in Sweden, which had a less stringent lockdown policy, it decreased slightly until July 2020 (AMPC -3.3% [95% CI -21.6% to 20.3%]), but increased thereafter (AMPC 13.6% [95% CI -12.6% to 27.0%]). The change of incidence rate in Sweden occurred mainly in elderly-onset patients, the only population with significant restrictions during the pandemic.

Conclusion: The incidence of IBD decreased during the pandemic in association with lockdowns, more so in Israel, which had more stringent policies. Future studies are needed to determine the long-term effect of the pandemic on IBD.