A nationwide cohort study of the incidence of inflammatory bowel disease in Sweden from 1990 to 2014

Forss, Anders; Clements, Mark; Bergman, David; Roelstraete, Björn; Kaplan, Gilaad G.; Myrelid, Pär; Halfvarson, Jonas; Olén, Ola; Ludvigsson, Jonas F.

doi:10.1111/apt.16735

Cited by 33 publications

(30 citation statements)

References 35 publications

(114 reference statements)

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“…Paediatric CD was more prevalent than paediatric UC in our study. This observation is similar to those from studies in France and Canada, but not Sweden 14,17,18 . Additionally, the prevalence of UC in elderly individuals was much higher in our study than that in other countries.…”

Section: Discussionsupporting

confidence: 91%

“…This observation is similar to those from studies in France and Canada, but not Sweden. 14,17,18 Additionally, the prevalence of UC in elderly individuals was much higher in our study than that in other countries. Further epidemiologic studies are needed to understand the factors driving these regional or ethnic differences.…”

Section: Discussioncontrasting

confidence: 59%

“…In contrast, a Swedish cohort analysis revealed an increasing trend in IBD incidence from 1990 to 2001, followed by a subsequent decline. 17 Meticulous selection of cases and surveillance of population-based cohorts may be needed to clearly understand the current increases in paediatric IBD prevalence. A study in Canada, which has the highest incidence of childhood-onset IBD worldwide, reported that the prevalence of childhood IBD has significantly increased over time; however, changes in the incidence had a modest impact on the overall prevalence, except for a rapid increase in the incidence in younger age groups.…”

Section: Discussionmentioning

confidence: 99%

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Treatment patterns of anti‐tumour necrosis factor‐alpha and prognosis of paediatric and adult‐onset inflammatory bowel disease in Korea: a nationwide population‐based study

Choe

Han

Shim

2022

Aliment Pharmacol Ther

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Summary Background The global prevalence of inflammatory bowel disease (IBD) is increasing. However, population‐level data are scarce for Asian populations. Aims To outline and compare paediatric and adult IBD incidence and prevalence data in Korea, describe prescription patterns, and analyse outcomes of anti‐tumour necrosis factor (anti‐TNF) use in a nationally representative cohort Methods IBD was identified based on the presence of Rare and Intractable Disease diagnosis codes for Crohn's disease (CD) and ulcerative colitis (UC). We calculated age‐based prevalence and incidence, and examined prescription patterns. We used a Cox proportional hazard model to calculate the hazard ratio (HR) for undergoing surgery. Results The prevalence of CD increased between 2006 and 2015, particularly among those aged 10–19 years (12.7–35.5 patients per 100,000 people). The use of anti‐TNF agents increased from 3.2% to 22.9% in paediatric CD patients. Early use of an anti‐TNF agent increased 25‐fold in CD patients. Further, CD patients aged 0–14 years were most likely to undergo fistulectomy (HR, 2.63; 95% confidence interval [CI], 1.73–3.97). Children with UC had a higher risk of undergoing surgery (HR, 3.01; 95% CI, 1.33–6.83) than adults. Early use of an anti‐TNF agent in CD patients was associated with lower odds of surgery than late‐stage use. Conclusion The prevalence of IBD has increased over time, especially among paediatric patients. Given the magnitude of paediatric IBD disease burden, a multi‐faceted approach is needed for early detection and vigilant monitoring to aim for better prognosis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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Treatment patterns of anti‐tumour necrosis factor‐alpha and prognosis of paediatric and adult‐onset inflammatory bowel disease in Korea: a nationwide population‐based study

Choe

Han

Shim

2022

Aliment Pharmacol Ther

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“…ICD codes for obesity, alcohol-related disorders, and chronic obstructive pulmonary disease (COPD) (as a proxy for smoking) were used and hazard ratios for death and cancer were calculated adjusted for these variables [21,22]. Similarly, we excluded any subjects with inflammatory bowel disease at baseline, defined according to recent study (C 1 colorectal biopsy with inflammation plus C 1 ICD code) [23]. This latter definition has a positive predictive value of 95% [24].…”

Section: Statisticsmentioning

confidence: 99%

Mortality and cancer in eosinophilic gastrointestinal disorders distal to the esophagus: nationwide cohort study 1990–2017

Bledsoe

Garber

et al. 2022

J Gastroenterol

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Background Eosinophilic gastrointestinal disorders (EGIDs) include inflammatory conditions with enteric infiltration of eosinophils and resulting symptoms. This study aims to examine a population-based sample of patients for prevalence, mortality, and cancer risk in EGIDs distal to the esophagus. Methods Nationwide, population-based cohort study. EGID was identified through relevant biopsy codes from Sweden’s all 28 pathology departments through the ESPRESSO cohort. Individuals with EGID were then matched to general population reference individuals with similar age and sex. Study participants were linked to Swedish healthcare registers. Through Cox regression, we calculated adjusted hazard ratios (aHRs) adjusting for sex, age, county, calendar period, and education. Results In total, 2429 patients (56% female) were found to have EGID distal to the esophagus, representing a prevalence of about 1/4800 in the Swedish population. Mean age was 44 years with 11% children at the time of diagnosis. Mortality was increased 17% in patients with EGIDs compared to reference individuals (aHR = 1.17; 95%CI = 1.04–1.33). Excess mortality was seen in gastric and small bowel eosinophilic disease, but not colonic disease (aHR = 1.81; 95%CI = 1.32–2.48, aHR = 1.50; 95%CI = 1.18–1.89, and aHR = 0.99; 95%CI = 0.85–1.16, respectively). Cause specific mortality was driven by cancer-related death (aHR = 1.33; 95%CI = 1.05–1.69). However, this study failed to show an increase in incident cancers (aHR = 1.14; 95%CI = 0.96–1.35). Comparison of EGID individuals with their siblings yielded similar aHRs. Conclusions This study found an increased risk of death in patients with EGIDs distal to the esophagus, with cancer death driving the increase. Proximal gut disease seems to confer the greatest risk. There was no increase in incident cancers.

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“…Additionally, there is a clear north–south gradient for CD incidence rates, with European countries in the north having a much higher rate [ 3 ]. In Sweden, the CD incidence rate was 8.1 per 100,000 person–years from 1990 to 2014 [ 4 ], and the prevalence of CD was 0.19% in 2010 [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Adherence to and Persistence with Adalimumab Therapy among Swedish Patients with Crohn’s Disease

2022

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Objectives: (1) to determine the adherence and persistence rates of adalimumab therapy among Swedish patients with Crohn’s disease (CD), and (2) to compare self-administration devices to predict the medication adherence and persistence. Methods: We conducted a retrospective analysis of the Swedish National Board of Health and Welfare database during a unique time period, when both the pen and the syringe were available. The pen was proposed to indicate a larger extent of internal control, according to health locus of control. Medication adherence was defined as a medication possession ratio (MPR) ≥ 0.8. A patient was considered nonpersistent if the time between any two dispensing records, minus the days of supply dispensed exceeded 180 days. The predictors of adherence were evaluated using a logistic regression, and the predictors of persistence were evaluated using a Cox proportional hazards model. Results: Among the 1083 patients studied, 89% were adherent and 77% were persistent. The patients using the pen and the patients treated in gastroenterology centers were more likely to be adherent and less likely to be nonpersistent. Conclusions: The adherence rate to adalimumab therapy was 89% and the one-year persistence rate was 70%. The pen and treatment in a gastroenterology center had a positive impact on the adherence and persistence among Swedish patients with CD.

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A nationwide cohort study of the incidence of inflammatory bowel disease in Sweden from 1990 to 2014

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 33 publications

References 35 publications

Treatment patterns of anti‐tumour necrosis factor‐alpha and prognosis of paediatric and adult‐onset inflammatory bowel disease in Korea: a nationwide population‐based study

Treatment patterns of anti‐tumour necrosis factor‐alpha and prognosis of paediatric and adult‐onset inflammatory bowel disease in Korea: a nationwide population‐based study

Mortality and cancer in eosinophilic gastrointestinal disorders distal to the esophagus: nationwide cohort study 1990–2017

Adherence to and Persistence with Adalimumab Therapy among Swedish Patients with Crohn’s Disease

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