Incidence, Outcomes, and Health Services Burden of Very Early Onset Inflammatory Bowel Disease
Open accessAbstract
Background & aims The Paris pediatric modification of the Montreal classification defines very early onset inflammatory bowel disease (VEO-IBD) as a form of IBD distinct from that of older children. We compared the incidence and outcomes of VEO-IBD with those of IBD in older children.Methods We performed a population-based retrospective cohort study of all children diagnosed with IBD in Ontario, Canada, from 1994 through 2009. Trends in standardized incidence were calculated using Poisson regression. We compared outpatient and emergency department visits, hospitalizations, and surgeries among children diagnosed with IBD when they were younger than age 6, ages 6-9.9, and older than age 10 years. Multivariable models were adjusted for income and stratified by sex.Results The incidence of IBD increased from 9.4 per 100,000 children (95% confidence interval [CI], 8.2-10.8/100,000 children) in 1994 to 13.2 per 100,000 children (95% CI, 11.9-14.6/100,000 children) in 2009 (P < .0001). The incidence increased by 7.4% per year among children younger than 6 years old and 6-9.9 years old, and by 2.2% per year among children ≥10 years old. IBD-related outpatient visits were less frequent among children <6 years old than ≥10 years old (odds ratio for female patients, 0.67; 95% CI, 0.58-0.78; odds ratio for male patients, 0.86; 95% CI, 0.75-0.98). Hazard ratios [HRs] for hospitalization were lower for children <6 years old (female HR, 0.70; 95% CI, 0.56-0.87; male HR, 1.12; 95% CI, 0.94-1.33) than for older children. HRs for surgery among children <6 years old with Crohn's disease were 0.35 for female patients (95% CI, 0.16-0.78) and 0.59 for male patients (95% CI, 0.34-0.99). HRs for children <6 years old with ulcerative colitis were 0.88 for female patients (95% CI, 0.47-1.63) and 0.42 for male patients (95% CI, 0.21-0.85). There was no difference in hospitalization or surgery rates among children 6-9.9 years old vs those ≥10 years old.Conclusions Based on a retrospective cohort study, the incidence of VEO-IBD increased from 1994 through 2009. Children diagnosed with IBD before they were 6 years old used fewer health services and had lower rates of surgery than children diagnosed when they were 10 years or older.
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Some studies have found that IBD incidence in children, including very early onset IBD, increased in the Western world over the past two decades.
“By contrast, some studies have found that IBD incidence in children38, including IBD of very early onset39, has increased in the Western world over the past two decades.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [39]
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- Authors
- Benchimol, E. I., Mack, D. R., Nguyen, G. C., Snapper, S. B., Li, W., Mojaverian, N., Quach, P., & Muise, A. M.
- Affiliations
- University of Ottawa (CA)
- Mount Sinai Hospital (CA)
- Boston Children's Hospital (US)
- Institute for Clinical Evaluative Sciences (CA)
- Children's Hospital of Eastern Ontario (CA)
- University of Toronto (CA)
- Corresponding author
- Benchimol, Eric I.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 147
- Issue
- 4
- Pages
- 803-813.e7
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2074204777
- Cited by
- 255
- References
- 34
- Citations by year
- 2026: 4 · 2025: 16 · 2024: 19 · 2023: 24 · 2022: 20 · 2021: 18 · 2020: 21 · 2019: 31 · 2018: 30 · 2017: 30 · 2016: 19 · 2015: 19 · 2014: 1 · 2013: 1
- FWCI
- 15.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Leona M. and Harry B. Helmsley Charitable Trust (AI50950, DK034854, HL59561, MOP119457)
- Ontario Ministry of Health and Long-Term Care (AI50950, DK034854, HL59561, MOP119457)
- American College of Gastroenterology (AI50950, DK034854, HL59561, MOP119457)
- Ontario Ministry of Research, Innovation and Science (AI50950, DK034854, HL59561, MOP119457)
- Institute for Clinical Evaluative Sciences (AI50950, DK034854, HL59561, MOP119457)
- Crohn's and Colitis Foundation of Canada (AI50950, DK034854, HL59561, MOP119457)
- National Institutes of Health (AI50950, DK034854, HL59561, MOP119457)
- Canadian Child Health Clinician Scientist Program (AI50950, DK034854, HL59561, MOP119457)
- Canadian Institutes of Health Research (AI50950, DK034854, HL59561, MOP119457)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Surgery › Gastrointestinal disorders and treatments
- Keywords
- very early onset inflammatory bowel disease, pediatric inflammatory bowel disease, Crohn's disease, ulcerative colitis, incidence trends, hospitalization, outpatient visits, emergency department visits, sex differences, Montreal classification, children under 6 years, Ontario, health care costs, health care utilization, income inequality, sex disparities
- MeSH terms
- Adolescent, Ambulatory Care, Child, Child, Preschool, Colectomy, Colitis, Ulcerative, Crohn Disease, Emergency Service, Hospital, Female, Health Services, Hospitalization, Humans, Infant, Male, Ontario, Retrospective Studies, Time Factors, Incidence, Prevalence, Multivariate Analysis, Logistic Models, Proportional Hazards Models, Odds Ratio, Treatment Outcome, Age of Onset, Kaplan-Meier Estimate
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