Epidemiology of IBD and Mortality and Morbidity Outcomes

Abstract

Purpose: Clinicians at our hospital routinely deal with Inflammatory Bowel Disease (IBD) inpatients. However, no database existed to evaluate IBD prevalence, assess demographic variability, mortality, co-morbid associations and consult burden on other specialties. We embarked on this first of its kind study at our hospital to gather this unique and extensive data which can be further analyzed locally and nationally. Methods: We retrospectively reviewed charts of all 197 IBD patients who were admitted at our hospital from 2007-2010. Data gathering beyond 2007 was not performed because of the logistic challenge of retrieving old charts. Results: Prevalence of Ulcerative Colitis (UC) was higher than Crohn's disease (CD) in our patients which correlates with the national prevalence pattern. Both UC and CD had a female predominance being 60% and 63%, respectively. Interestingly, national figures show an unexplained increase of male predominance in UC patients. A typical “bimodal” distribution of age for IBD was noted in both UC and CD in contrast to a more nationwide emerging pattern of unimodal peak for CD followed by a steady decrease. Both UC and CD were predominantly common among African-Americans than Caucasians. However, other minority groups as Asians and Hispanics were at par with African Americans (38 % vs 38%) in UC and exceeded the number for CD (53% vs 28%). Smoking rates were comparable between UC and CD patients (13% vs 15%). All cause inpatient mortality rates for UC and CD were 4.6% and 0%, respectively. Approximately half of the IBD inpatients had a CT performed and the majority, about 90%, had pertinent findings which did not necessary always alter the diagnostic or therapeutic course of the disease. Surgical consults were called more often for CD than UC patients, 34% vs 20% of the time but not many had an actual surgical intervention. GI consult was almost always invariably called for both UC and CD patients. For both IBD subsets, only about 40% patients had an inpatient colonoscopy with 90-100% chance of positive findings. Both for UC and CD, 65% patients never had a stool CDiff ordered. However, C-Diff predominance was seen in UC compared to CD, 8.5% vs 3%, in subset of IBD patients who did actually get a stool sampling done for C-Diff. Conclusion: The Crohn's and Colitis Foundation of America attributes the lack of epidemiological databases as a particular constraint in IBD related research. Creation and maintenance of such databases would provide new opportunities to apply standard and innovative epidemiological techniques to monitor IBD prevalence, discover the etiologies of IBD, assess estimates of resource utilization and define populations at greatest or least risk.