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Declining hospitalisation and surgical intervention rates in patients with Crohn's disease: a population‐based cohort

2019; Wiley; Volume: 50; Issue: 10 Linguagem: Inglês

10.1111/apt.15511

1365-2036

Adam Rahman, Vipul Jairath, Brian G. Feagan, Reena Khanna, Salimah Z. Shariff, Britney Allen, Krista Bray Jenkyn, Christopher Vinden, Jenny Jeyarajah, Mahmoud Mosli, Eric I. Benchimol,

Microscopic Colitis

Summary Background Lifetime risk of surgery in patients with Crohn's disease remains high. Aim To assess population‐level markers of Crohn's disease (CD) in the era of biological therapy. Methods Population‐based cohort study using administrative data from Ontario, Canada including 45 235 prevalent patients in the Ontario Crohn's and Colitis Cohort (OCCC) from 1 April 2003 to 31 March 2014. Results CD‐related hospitalisations declined 32.4% from 2003 to 2014 from 154/1000 (95% confidence interval (CI) [150, 159]) patients to 104/1000 (95% CI [101, 107]) ( P < .001). There was a 39.6% decline in in‐patient surgeries from 53/1000 (95% CI [50, 55]) to 32/1000 (95% CI [30, 34]) from 2003 to 2014 ( P < .001). In‐patient surgeries were mostly bowel resections. Out‐patient surgeries increased from 8/1000 (95% CI [7, 9]) patients to 12/1000 (95% CI [10, 13]) ( P < .001). Out‐patient surgeries were largely related to fistulas and perianal disease and for stricture dilations/stricturoplasty. CD‐related emergency department (ED) visits declined 28.4% from 141/1000 (95% CI [137, 146]) cases to 101/1000 (95% CI [99, 104]) from 2003 to 2014 ( P < .001). Over the same time, patients receiving government drug benefits received infliximab or adalimumab at a combined rate of 2.2% in 2003 which increased to 18.8% of eligible patients by 2014. Conclusions Rates of hospitalisations, ED visits and in‐patient surgeries markedly declined in Ontario over the study period, while rates of biologic medication use increased markedly for those receiving public drug benefits.