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The Incidence and Prevalence of Inflammatory Bowel Disease Among U.S. Veterans: A National Cohort Study

Hou, Jason K. MD*,†; Kramer, Jennifer R. PhD, MPH*,†; Richardson, Peter PhD*,†; Mei, Minghua PhD*,†; El-Serag, Hashem B. MD, MPH*,†

doi: 10.1097/MIB.0b013e31828028ca
Original clinical Articles

Background: Temporal trends in incidence and prevalence of Crohn's disease (CD) and ulcerative colitis (UC) in the United States have been reported only in regional populations. The Veterans Affairs (VA) health care system encompasses a national network of clinical care facilities. The aim of this study was to identify temporal trends in the incidence and prevalence of CD and UC among VA users using national VA data sets.

Methods: Veterans with CD and UC were identified during fiscal years 1998 to 2009 in the national VA outpatient and inpatient files. Incident and prevalent cases were identified by diagnosis code, and age-standardized and gender-standardized annual prevalence and incidence rates were estimated using the VA 1998 population as the standard population.

Results: The total of unique incident cases were 16,842 and 26,272 for CD and UC, respectively; 94% were men. The average annual age-standardized and gender-standardized incidence rate of CD was 33 per 100,000 VA users (range, 27–40), whereas the average for UC was 50 per 100,000 VA users (range, 36–65). In 2009, the age-standardized and gender-standardized point prevalence rate of CD was 287 per 100,000 VA users, whereas the point prevalence of UC was 413 per 100,000 VA users.

Conclusions: Prevalence of CD and UC increased 2-fold to 3-fold among VA users between 1998 and 2009. The incidence of UC decreased among VA users from 1998 to 2004 but has remained stable from 2005 to 2009. The incidence of CD has remained stable during the observed time period.

Article first published online 27 February 2013

*Houston VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas

Department of Medicine, Baylor College of Medicine, Houston, Texas.

Reprints: Jason K. Hou, MD, 1709 Dryden Road, Suite 8.40, MS: BCM 620, Houston, TX 77030 (e-mail:

Supported in part by the American College of Gastroenterology Junior Faculty Development Award to J. K. Hou, a pilot grant from the Houston VA HSR&D Center of Excellence (HFP90-020) to J. K. Hou, and by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, grant MRP05-305 to J. R. Kramer.

The authors have no conflicts of interest to disclose.

Received July 19, 2012

Accepted July 26, 2012

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