P2227 - Longitudinal Trends in Inflammatory Bowel Disease Hospitalizations in the Era of Biologics: A 20 Year Nationwide Study

Ellen J. Spartz, MD, Vivy Cusumano, MD, Jenny Sauk, MD, Berkeley Limketkai, MD, PhD
UCLA, Los Angeles, CA

Introduction: Infliximab was the first biologic approved for Crohn’s disease (CD) in 1998, heralding an era of powerful immunosuppressive therapies. Two decades later, there are 11 FDA-approved biologic agents and small molecule inhibitors for the management of inflammatory bowel disease (IBD). It remains unclear whether the availability of these agents has had an impact on hospitalizations, a surrogate for IBD disease severity and failure of outpatient medical treatments. The aim of this study was to examine the overall epidemiology and longitudinal trends of IBD-related hospitalizations in the era of biologics.

Methods: This retrospective study analyzed the National Inpatient Sample (NIS) databases from 1998-2018. Hospitalizations for ulcerative colitis (UC) and CD were identified by the International Classification of Diseases (ICD)-9 and 10 codes in the first 3 diagnosis positions. Hospitalization trends were evaluated according to time, age group (every 2 decades), sex, and race. Denominators included IBD-only hospitalizations, all-cause hospitalizations, and the United States (US) population.

Results: From 1998 through 2018, there was a rising trend for UC (14.0 to 26.0/100,000 population; p trend< 0.01) and CD hospitalizations (23.0 to 43.8/100,000 population; p trend< 0.01), despite all-cause hospitalizations beginning to decline after 2008 (Figure 1). Hospitalizations for CD were consistently more frequent than those with UC (Table 1). The proportion of hospitalizations significantly increased among individuals ≥60 years of age with CD and UC (p trend< 0.01), but remained stable in the non-IBD population; IBD-related hospitalizations for other age groups remained stable or declined. Over the two decades, there was a steady decline in proportion of hospitalizations of white CD and UC individuals and increase within each minority racial/ethnic demographic. There was no difference in hospitalizations based on gender.

Discussion: Over the past 20 years since the introduction of biologics for IBD, the numbers and proportions of hospitalizations for both UC and CD have increased, exceeding epidemiologic changes in all-cause hospitalizations and the US population. The proportion of hospitalizations increased for elderly (≥60) and non-white individuals, but remained stable for other demographics. These shifts in the IBD-related hospitalizations patterns likely reflect the increasing incidence and prevalence of IBD as well as the changing demographics of IBD.



Disclosures:


Ellen J. Spartz, MD, Vivy Cusumano, MD, Jenny Sauk, MD, Berkeley Limketkai, MD, PhD. P2227 - Longitudinal Trends in Inflammatory Bowel Disease Hospitalizations in the Era of Biologics: A 20 Year Nationwide Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.