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Nationwide Temporal Trends in Incidence of Hospitalization and Surgical Intestinal Resection in Pediatric Inflammatory Bowel Diseases in the United States from 1997 to 2009

deBruyn, Jennifer C. C. MD, MSc*; Soon, Ing Shian MD, MSc*; Hubbard, James MSc; Wrobel, Iwona MD*; Panaccione, Remo MD; Kaplan, Gilaad G. MD, MPH†,‡

doi: 10.1097/MIB.0b013e3182a56148
Original Clinical Articles

Background: Data are limited on temporal trends in outcomes of hospitalization and surgery in pediatric Crohn's disease (CD) and ulcerative colitis (UC). Thus, we evaluated the U.S. nationwide temporal trends for incidence of hospitalization and intestinal resection along with associated resource utilization.

Methods: We used the Kids' Inpatient Database (1997, 2000, 2003, 2006, and 2009) to identify all admissions for children aged 18 years or younger with a primary CD (International Classification of Diseases, Ninth Revision [ICD-9]: 555.X) or UC (ICD-9: 556.X) diagnosis or a secondary CD or UC diagnosis and procedural code of intestinal resection. Poisson regression analysis was performed to evaluate time trends in the incidence of hospitalization, intestinal resection, and hospital resource utilization.

Results: The annual incidence of hospitalization was 5.7 and 3.5 per 100,000 children for CD and UC, respectively, with significant increases over time for CD (annual percent increase [API], 3.8%; 95% confidence interval [CI], 3.0%–4.5%) and UC (API, 4.5%; 95% CI, 4.3%–4.7%). Median hospital days per hospitalization for CD and UC remained stable, whereas median charge per hospitalization increased for CD (API, 4.1%; 95% CI, 2.6%–5.6%) and UC (API, 4.7%; 95% CI, 3.5%–5.9%). The annual incidence of intestinal resection remained stable for UC at 0.6 per 100,000 children but climbed for CD (API, 2.1%; 95% CI, 0.1–4.2).

Conclusions: The annual incidence of hospitalization is climbing in pediatric inflammatory bowel diseases, accompanied by rising intestinal resection rates for CD and stable colectomy rates for UC. With escalating resource utilization, the economic and health burden of pediatric inflammatory bowel diseases is substantial.

Article first published online 23 August 2013

Departments of *Pediatrics,

Community Health Sciences, and

Medicine, University of Calgary, Calgary, Canada.

Reprints: Jennifer C. C. deBruyn, MD, MSc, Department of Paediatrics, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada (e-mail:

J. C. C. deBruyn and I. Wrobel are members of the Alberta Children’s Hospital Research Institute. J. C. C. deBruyn has participated in advisory board meetings and received research support from Janssen. G. G. Kaplan has served as a speaker for Merck, Schering-Plough, Abbott, and UCB Pharma. He has participated in advisory board meetings for Abbott, Merck, Schering-Plough, Shire, and UCB Pharma. G. G. Kaplan has received research support from Abbott and Shire. R. Panaccione has served as a speaker, a consultant and an advisory board member for Abbott Laboratories, Merck, Schering-Plough, Shire, Centocor, Elan Pharmaceuticals, and Procter and Gamble. He has served as a consultant and speaker for Astra Zeneca; a consultant and an advisory board member for Ferring and UCB; a consultant for Glaxo-Smith Kline and Bristol Meyers Squibb; and a speaker for Byk Solvay, Axcan, Jansen, and Prometheus. R. Panaccione has received research funding from Merck, Schering-Plough, Abbott Laboratories, Elan Pharmaceuticals, Procter and Gamble, Bristol Meyers Squibb, and Millennium Pharmaceuticals. He has received educational support from Merck, Schering-Plough, Ferring, Axcan, and Jansen. The remaining authors have no conflicts of interest to disclose.

Received June 10, 2013

Accepted July 16, 2013

© Crohn's & Colitis Foundation of America, Inc.
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