Photo Credit: Manuel-F-O
Advances in the management of IBD may support a shift from hospital-based care to community-based care.
According to findings published online in Clinical Gastroenterology and Hepatology, global hospitalization trends for inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), were stable among primary hospitalizations in the Western world. Researchers suggest that advances in the management of IBD are supporting a shift from hospital-based care to community-based care.
“The advent of modern therapeutics, specifically monoclonal antibodies, occurred at the turn of the 21st century and revolutionized the medical management of IBD,” lead study author Michael J. Buie, MSc, and colleagues wrote.
Understanding Global Trends
The study authors explained that there have been paradigm shifts within management strategies and an increased number of practice guidelines over the last 20 years. Additionally, innovations in therapeutics and clinical management algorithms have supported the transition of moderate to severe IBD management from the hospital to outpatient settings in Western countries.
To better understand how hospitalization trends varied globally, Buie and colleagues conducted a systematic review with temporal analyses of hospitalization rates in the 21st century for population-based studies reporting hospitalizations for persons with IBD, CD, or UC. The researchers hypothesized that they would see some regions of the world with significantly higher hospitalization rates.
Using MEDLINE and EMBASE databases for their literature review, the study team used IBD-specific and hospitalization-related terms for population-based studies published between January 1, 2000, and April 26, 2022.
“The systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses and the Meta-analyses Of Observational Studies in Epidemiology checklists,” they explained.
After extracting the data, the authors defined yearly IBD hospitalization rates as the number of hospitalized cases in a population per 100,000 person-years.
“Yearly IBD hospitalization rates per prevalent IBD population were defined as the number of hospitalized cases in a population per 100 prevalent IBD patients,” explained the research team. “Annual data on hospitalization rates were categorized by IBD, CD, or UC.”
Buie and colleagues developed their temporal analysis using data from studies reporting at least 3 data points over a 5-year period to calculate the average annual percentage change (AAPC) in hospitalization rates with associated 95% confidence intervals (95% CIs). They defined CIs less than zero as significantly decreasing, CIs crossing zero as stable, and CIs greater than zero as significantly increasing.
Furthermore, the authors stratified each study’s AAPC in hospitalization rate for IBD, CD, and UC and calculated pooled AAPCs for each country. “We excluded studies that were unclassified by hospital type and stratified by primary diagnosis vs all-cause hospitalization. Random-effects meta-analyses were used to pool AAPCs with 95% CIs owing to heterogeneity between studies,” they said.
How Hospitalizations Compare
Based on the study criteria, 12,686 citations were reviewed. Of those, 84 studies providing hospitalization rates for IBD from 42 countries were identified. The research team conducted temporal analyses on data from 27 studies encompassing 35 countries or regions. Furthermore, of the 84 studies, 6 reported or enabled the calculation of hospitalization rates per 100 IBD, CD, or UC patients.
The researchers note that there were no population-based studies available for developing regions.
The findings suggest some countries show stable hospitalization rates for IBD (AAPC, −0.32%; 95% CI, −0.95 to 0.30), CD (AAPC, 1.12%; 95% CI, −2.13 to 4.37), and UC (AAPC, 0.71%; 95% CI, −2.28 to 3.71) since 2000. Additionally, newly industrialized countries have significantly increased hospitalization rates for IBD (AAPC, 4.67%; 95% CI, 2.63 to 6.72) and CD (AAPC, 7.28%; 95% CI, 3.62 to 10.94), but hospitalization rates for UC were stable (AAPC, 2.60%; 95% CI, −0.06 to 5.26).
“Several clinical factors have influenced hospitalization rates in countries of the Western world in stage 3 during the 21st century,” the authors explained. “The advent of biological therapies revolutionized the medical management of IBD, leading to a reduction in the need for hospital-based care and surgery for intestinal resections.”
In addition to clinical factors, the authors report several new guidelines that have been published that have advanced clinical management of IBD beyond medical therapeutics.
The research team says some countries will need to address the increasing burden of IBD to ensure their healthcare systems optimize medical management with the goal of shifting care from the hospital to the community.
“Collectively, these data offer insight into a differential health care burden that IBD may pose across the world,” they concluded.
