Decade-Long Trends in Hospitalization, Outcomes, and Emergency Department Visits for Inflammatory Bowel Diseases in the United States, 2010 to 2020

Abstract

Background Data on trends in inflammatory bowel disease (IBD) hospitalizations in the literature are sparse and conflicting. This study evaluated trends in hospitalization and emergency department (ED) visits for IBD between 2010 and 2020 using large data from the United States national inpatient and emergency department sample databases. Methods We employed joinpoint regression analysis and Cuzick’s tests to examine trends in hospitalizations, emergency department (ED) visits, and outcomes of hospitalization for IBD using nationwide inpatient and ED sample databases. Hospitalization costs were adjusted for inflation using the medical expenditure panel survey index. Results We analyzed 2,504,288 Crohn's Disease (CD) and 1,367,809 ulcerative colitis (UC) hospitalizations. There was an uptrend in the mean age of patients with IBD from 52.3 years in 2010 to 55.8 years in 2020 (P <0.001). Hospitalizations for IBD showed an upward trend with an average annual percent change (APC) of 0.92% (confidence interval [CI]: 0.67-1.17; P<0.001) and a marked increase in CD hospitalization until 2014 (APC, 2.16%; CI, 1.35-4.64; P=0.040). After 2014, CD hospitalizations showed a downward trend to 219,200 with an AAPC of -0.1% (CI: -1.79 to 1.61; P=0.890), whereas UC hospitalizations steadily increased over the decade (120,346 to 122,485; APC, 0.63%; CI, 0.52-0.74; P<0.001). Mortality rates increased by an average APC of 3.16% (P=0.002), especially among the middle-aged and older adults. Aggregate annual IBD hospitalization costs were $9.1 billion higher in 2020 than in 2010 (APC: 3.97% (CI: 2.98-4.97; P<0.001). There were 6,243,807 ED visits for IBDs over the study period. There was no significant change in the overall number of ED visits for IBD over the study period (574,038 to 448,647; APC: 0.1%; CI: -0.42 to 0.54; P=0.792). There was an uptrend in the total number of in-hospital procedures for IBD (622,647 to 642,210; APC: 0.64%; CI: 0.35-0.93; P=0.001). There was an uptrend in the incidence of combined incidences of malnutrition, anemia, bowel perforations, fistulae, and critical care admission for IBD (Ptrend for all < 0.001). Conclusion IBD hospitalization rates have increased with aging patient demographics, rising mortality rates, and increased healthcare spending over the past decade.