Crohn's Disease Hospitalization Rates Stable, Despite New Drugs

Diana Phillips

April 14, 2017

The hospitalization rate for Crohn's disease has remained relatively stable during a 10-year period, although the proportion of these hospitalizations that involved small bowel resection declined slightly, new research has shown.

The findings, reported in the April 14 issue of the Morbidity and Mortality Weekly Report  (MMWR), may reflect a reversal in the trend of increased hospitalizations and surgical procedures. Christopher A. Malarcher, from Oxford College of Emory University, Georgia, and colleagues from the Centers for Disease Control and Prevention, also suggest that available treatments have not increased clinical remissions or reduced hospitalizations.

To estimate US hospitalizations for Crohn's disease, the investigators used hospital discharge data from the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2003 to 2013, the most recent decade of data. They included patients for whom first-listed or any listed diagnosis for admission was Crohn's disease.

The age-adjusted hospitalization rate for first-listed Crohn's diagnosis in 2003 was 18.2 per 100,000 population, rising slightly but not significantly to 19.1 in 2013, the authors report. They note that this is a departure from the 4.3% annual increase reported for a first-listed diagnosis in an earlier, but overlapping, period, from 1998 to 2004.

In contrast, a sharp increase was observed in the age-adjusted hospitalization rate for patients with any listed Crohn's diagnosis, rising 35.1% during the study period, from 44.2 per 100,000 population in 2003 to 59.7 in 2013. "This increase might represent greater physician awareness and diagnosis of Crohn's disease or more complete coding of secondary diagnoses by physicians," the authors write.

The proportion of hospitalizations with first-listed Crohn's diagnosis during which small bowel resection was performed decreased from 4.9% in 2003 to 3.9% in 2013. However, the rate for colorectal resection remained stable (14.8% in 2003 and 12.8% in 2013), as did the rate for fistula repair (1.8% in 2003 and 2% in 2013).

These surgical trends also contrast with those observed from 1993 to 2004, "when rates of small bowel and right colon resection did not change and fistula repairs increased significantly," the authors write.

"[T]he declines in small bowel resection during hospitalizations [between 2003 and 2013] might represent a decrease in clinical severity, possibly related to newer therapies," the authors hypothesize.

The investigators also observed variation in hospitalization rates by gender and geographic location. Specifically, for first-listed diagnoses, age-adjusted hospitalization rates increased by 14.5% among males, from 15.4 per 100,000 population in 2003 to 17.6 in 2013 (P < .05), whereas the rates were flat among females (20.7 per 100,000 population in 2003 and 20.5 in 2013)

When analyzed by location, the age-adjusted rate of hospitalization ranged from 19.2 per 100,000 population in Hawaii to 91.6 in Rhode Island. "States with the lowest hospitalization rates were clustered in the Southwest and Rocky Mountain states," the authors write.

The geographic variation is similar to that observed in earlier reports, according to the authors. "Whether this consistent regional pattern is the result of variations in physician awareness and diagnosis of Crohn's disease or variations in risk factors for Crohn's disease is unknown."

Treatment for Crohn's disease is usually progressive, beginning with aminosalicylate drugs and corticosteroids and moving to immunomodulators and other biologic therapies. The increased use of immunomodulatry and biologic drugs was expected to improve remission and reduce hospitalizations.

Although the findings suggest that "the available treatments have not increased clinical remissions or reduced hospitalizations, it is possible that these trends indicate the beginning of a reversal of the increased hospitalizations and surgical procedures observed in the years leading up to the study period," the authors write.

The cause of Crohn's disease is unknown. As such, "it is difficult to determine what changes in public health practice could help prevent it," the authors write. Possibilities include increased patient education around exacerbating factors, including smoking and stress, and the importance of medication compliance to prevent hospitalizations. Additionally, "[p]rofessional education should continue to increase awareness of the signs and symptoms of Crohn's disease and improve diagnosis and management," they conclude.

MMWR. Published online April 14, 2017. Full text

The authors have disclosed no relevant financial relationships.

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