Prevalence of paediatric inflammatory bowel disease in Sweden: a nationwide population-based register study

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Abstract

Background

We evaluated the impact of different case definition algorithms on the prevalence of paediatric inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) and to compare the occurrence of certain diseases compared to matched controls.

Methods

Paediatric patients (<18 years) were identified via ICD codes for UC and CD in Swedish registers between 1993 and 2010 ( n = 1432). Prevalence was defined as ≥2 IBD-related visits. Prevalence of treated children in 2010 was defined as ≥2 IBD-related visits with one visit and ≥1 dispensed IBD-related drug prescription in 2010. To test the robustness of the estimates, prevalence was also calculated according to alternative case definitions. The presence of rheumatic, hepatobiliary, pancreatic, and dermatologic diseases were compared with age-/sex-/county-of-residence-matched general population controls.

Results

The IBD prevalence was 75/100,000 (CD: 29/100,000; UC: 30/100,000; patients with IBD-U: 16/100,000). Prevalence of treated disease in 2010 was 62/100,000 (CD: 23/100,000; UC: 25/100,000; patients with IBD-U: 13/100,000). When age restrictions were employed, the prevalence estimate decreased (<17y: 61/100,000, <16y: 49/100,000 and <15y: 38/100,000).

Compared to general population controls ( n = 8583), children with IBD had a higher prevalence of dermatologic (4.7% vs. 0.6%), hepatobiliary (including primary sclerosing cholangitis) (5.5% vs. 0.1%), pancreatic (1.7% vs. 0%) and rheumatic diseases (7.2% vs. 1.2%; all P < 0.01).

Conclusions

The overall prevalence of paediatric IBD in Sweden was similar to that in earlier regional cohorts. IBD patients had a higher prevalence of comorbid conditions than matched general population controls.

Electronic supplementary material

The online version of this article (doi:10.1186/s12876-017-0578-9) contains supplementary material, which is available to authorized users.

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Most cited references 19

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World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010.

Eyleen L. K. Goh, A LeMair, Charles Bernstein … (2009)

Inflammatory bowel disease (IBD) represents a group of idiopathic, chronic, inflammatory intestinal conditions. Its two main disease categories are: Crohn's disease (CD) and ulcerative colitis (UC), which feature both overlapping and distinct clinical and pathological features. While these diseases have, in the past, been most evident in the developed world, their prevalence in the developing world has been gradually increasing in recent decades. This poses unique issues in diagnosis and management which have been scarcely addressed in the literature or in extant guidelines. Depending on the nature of the complaints, investigations to diagnose either form of IBD or to assess disease activity will vary and will also be influenced by geographic variations in other conditions that might mimic IBD. Similarly, therapy varies depending on the phenotype of the disease being treated and available resources. The World Gastroenterology Organization has, accordingly, developed guidelines for diagnosing and treating IBD using a cascade approach to account for variability in resources in countries around the world.

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Increasing incidence of paediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data.

E Benchimol, J. Howard, Tanya Griffiths … (2009)

Health administrative databases can be used to track chronic diseases. The aim of this study was to validate a case ascertainment definition of paediatric-onset inflammatory bowel disease (IBD) using administrative data and describe its epidemiology in Ontario, Canada. A population-based clinical database of patients with IBD aged 99.9%; children 99.9%; children <18 years old, sensitivity 91.1%, specificity 99.5%). Age- and sex-standardised prevalence per 100 000 population of paediatric IBD has increased from 42.1 (in 1994) to 56.3 (in 2005). Incidence per 100 000 has increased from 9.5 (in 1994) to 11.4 (in 2005). Statistically significant increases in incidence were noted in 0-4 year olds (5.0%/year, p = 0.03) and 5-9 year olds (7.6%/year, p<0.0001), but not in 10-14 or 15-17 year olds. Ontario has one of the highest rates of childhood-onset IBD in the world, and there is an accelerated increase in incidence in younger children.

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Age-related differences in presentation and course of inflammatory bowel disease: an update on the population-based literature.

, P L Lakatos, Corinne Gower-Rousseau … (2014)

Current data indicate a change in the epidemiology of inflammatory bowel diseases. The disease has become more widespread and the rise in the incidence has been reported in all age groups including early childhood and according to recent data also the elderly population. Some earlier studies have suggested that the phenotype and natural history of the disease may be different according to age of onset. Recently the importance of age at onset was reported in two population-based studies from France and Hungary including both paediatric and adult onset inception cohorts. Early onset disease was associated with more frequent disease extension in both Crohn's disease and ulcerative colitis and in most but not all studies with higher frequency of complicated disease behaviour. This is also accompanied by striking differences in the medical management with earlier and more prevalent (2-3-fold) use of immunosuppressives and to some extent biologicals in patients with early compared to elderly-onset disease, especially in Crohn's disease. However, the results of population-based studies on impact of age on surgery rates in Crohn´s disease as well as ulcerative colitis are conflicting. Furthermore, published data indicate that relative but not absolute risk of developing cancer and mortality is higher in patients with an early onset disease. Critical reviews that focus on the importance of age at onset in inflammatory bowel disease are rare. Therefore, the aim of this review is to describe the differences in epidemiology, clinical characteristics, and natural history of paediatric and elderly-onset inflammatory bowel disease based on studies performed in general population. Copyright © 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

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Author and article information

Contributors

J. F. Ludvigsson: jonasludvigsson@yahoo.com

Journal

Journal ID (nlm-ta): BMC Gastroenterol

Journal ID (iso-abbrev): BMC Gastroenterol

Title: BMC Gastroenterology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-230X

Publication date (Electronic): 31 January 2017

Publication date PMC-release: 31 January 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 23

Affiliations

[1 ]ISNI 0000 0001 0123 6208, GRID grid.412367.5, Department of Paediatrics, , Örebro University Hospital, ; Örebro, Sweden

[2 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Department of Medical Epidemiology and Biostatistics, , Karolinska Institutet, ; SE-171 76 Stockholm, Sweden

[3 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Department of Medicine Solna, Clinical Epidemiology Unit, , Karolinska Institutet, ; Stockholm, Sweden

[4 ]GRID grid.416452.0, Department of paediatric gastroenterology and nutrition, , Sachs’ Children and Youth Hospital, ; Stockholm, Sweden

[5 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Department of Rheumatology, , Karolinska University Hospital, ; Stockholm, Sweden

Article

Publisher ID: 578

DOI: 10.1186/s12876-017-0578-9

PMC ID: 5282815

PubMed ID: 28143594

SO-VID: 728e6e1f-cb25-4e45-9242-5faabac9664f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 30 April 2016

Date accepted : 18 January 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001729, Stiftelsen för Strategisk Forskning;

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ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: prevalence,paediatrics,inflammatory bowel disease,crohn’s disease,ulcerative colitis,sweden

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ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: prevalence, paediatrics, inflammatory bowel disease, crohn’s disease, ulcerative colitis, sweden

Prevalence of paediatric inflammatory bowel disease in Sweden: a nationwide population-based register study

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Karger: Gastroenterology

Most cited references 19

World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010.

Increasing incidence of paediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data.

Age-related differences in presentation and course of inflammatory bowel disease: an update on the population-based literature.

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