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

Benchimol EI, Mack DR, Nguyen GC, Snapper SB, Li W, Mojaverian N, Quach P, Muise AM. Gastroenterology. 2014; 147(4):803–813.e7. Epub 2014 Jun 18.

Background and 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 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 6 years old, 6-9.9 years old, and older than 10 years. Multivariable models were adjusted for income and stratified by sex.

Results — Incidence of IBD increased from 9.4/100,000 children (95% confidence interval [CI], 8.2-10.8/100,000 children) in 1994 to 13.2/100,000 children (95% CI, 11.9-14.6/100,000 children) in 2009 (P<.0001). Incidence increased by 7.4%/year among children <6 years old and 6-9.9 years old, and by 2.2%/year among children ≥10 years old. IBD-related outpatient visits were less frequent among children <6 years old than ≥10 years old (odds ratio [OR] for female patients, 0.67; 95% CI, 0.58-0.78 and OR 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 and 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 among children 6-9.9 years old vs those ≥10 years old.

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

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Keywords: Gastrointestinal disorders Health care utilization