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

Rahman A, Jairath V, Feagan BG, Khanna R, Shariff SZ, Allen BN, Jenkyn KB, Vinden C, Jeyarajah J, Mosli M, Benchimol E. Aliment Pharmacol Ther. 2019; Oct 17 [Epub ahead of print]. DOI: https://doi.org/10.1111/apt.15511


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.

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