Abstract
To assess absolute and relative risks of serious infections (resulting in inpatient care) in children with inflammatory bowel disease (IBD) compared with the general population. We identified children (<18years of age) with a first diagnosis of IBD in the Swedish nationwide health registry (2002-2017; n=5767) and individuals from the general population matched for sex, age, calendar year, and place of residence (reference group; n=58 418). Hazard ratios (HRs) for serious infections were estimated using Cox regression separately in children with ulcerative colitis (n=2287), Crohn's disease (n=2365), and IBD unclassified (n=1115). During 17 408 person-years of follow-up, 672 serious infections (38.6/1000 person-years) occurred among the children with IBD compared with 778 serious infections in the reference group (4.0/1000 person-years; adjusted HR (95% CI), 9.46 [8.53-10.5]). HRs were increased for children with ulcerative colitis 8.48 (7.21-9.98), Crohn's disease 9.30 (7.86-11.0), and IBD unclassified 12.1 (9.66-16.1). HRs were highest in the first year of follow-up (HR=12.6 [10.7-14.9]), then decreasing to a 4.8-fold increased risk beyond 10years of follow-up. Particularly high HRs were also seen in children with IBD undergoing surgery. Apart from a high relative risk of gastrointestinal infections resulting in hospitalization, children with IBD were also at an increased risk of opportunistic infections (HR=11.8 [6.17-22.5]). Children with IBD have an increased risk of serious infection requiring hospitalization compared with the general population.
Highlights
Children with inflammatory bowel disease (IBD) whose 2 first diagnostic listings were a mixture of Crohn’s disease (CD) or ulcerative colitis (UC) diagnoses or an International Classification of Disease (ICD) code of K52.3 were classified as having IBD unclassified (IBD-U) (Appendix, Supplementary Table 2).[22]
Results We identified 5766 children with IBD (2364 CD, 2287 UC, and 1115 IBD-U); Table I
Hazard ratios (HRs) were increased for children with UC (HR = 8.48; 7.219.98), CD (HR = 9.30; 7.86-11.0), and IBD-U (HR = 12.1; 9.66-15.1)
Summary
To assess absolute and relative risks of serious infections (resulting in inpatient care) in children with inflammatory bowel disease (IBD) compared with the general population. Inflammatory bowel disease (IBD) occurs in about 0.1% of the Swedish child population,[1] and 10% of all incident IBD occurs before the age of 18 years.[2] The disease is comprised by Crohn’s disease (CD), ulcerative colitis (UC), and a third entity, IBD unclassified (IBD-U).[3] Children with IBD are at increased risk of both cancer and death.[4,5] Among the highest relative risks of death is that from infectious conditions (hazard ratio [HR] = 6.3; 2.1-16.9).[4] our prior study on overall and cause-specific mortality included only 6 children with IBD who died from infections and 95% CI were wide.[4]. We hypothesized that pediatric IBD is associated with an increased relative risk of serious infections requiring hospitalization
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