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The Burden of IBD Charles N. Bernstein, MD University of Manitoba IBD Clinical and Research Centre Winnipeg, Manitoba, Canada. IBD Database Construction. Persons with at least one IBD contact, 1984-1995 (n=10,541). Apply case definitions to entire health database. Exclude if <3 contacts
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The Burden of IBD Charles N. Bernstein, MD University of Manitoba IBD Clinical and Research Centre Winnipeg, Manitoba, Canada
IBD Database Construction Persons with at least one IBD contact, 1984-1995 (n=10,541) Apply case definitions to entire health database Exclude if <3 contacts beginning prior to 1993 (n=5,359) Evaluate “case definitions” versus random charts (n=448) Distribute consent and demographic questionnaire to current residents. (n=4,514) Optimize “case definitions” versus self-reported diagnosis 60% “Crohn’s disease” (n=1,230) “Ulcerative colitis” (n=1,222) Analyze medical contact patterns for questionnaire respondents. (n=2,725) “No IBD” (n=273) Bernstein Am J Epidemiol 1999
Case Definitions: Crohn’s Disease and UC • At least 5 separate hospital/physician contacts with a diagnosis between 1984 and 1995. OR • If registered with Manitoba Health for <2 years, at least 3 separate hospital/physician contacts with a diagnosis. • If both CD and UC criteria were met, then the majority diagnosis of the most recent 9 contacts was used. • Diagnosis date is the first hospital/physician contact (applied only to first contacts beginning in 1988 or later).
Crohn’s disease prevalence and incidence, Manitoba, 1990 - 2001, cases/100,000, age standardized to the 1996 Manitoba population
UC prevalence and incidence, Manitoba, 1990 - 2001, cases/100,000 age standardized to the 1996 Manitoba population
Annual Age-Adjusted Prevalence of CD and UC, by First Nation (FN) Status, Manitoba. 250 209 Non-FN CD 200 176 Non-FN UC 150 Prevalence per 100,000 100 57 FN UC 50 14 FN CD 0 1987 1988 1989 1990 1991 1992 1993 1994 Blanchard Am J Epidemiol 2001
BC AB SK MB NS
Age-specific incidence of Crohn’s Disease: by Province Bernstein AJGI 2005
Age-specific incidence of UC: by Province (1998-2000) Bernstein AJGI 2005
Age-specific prevalence of Crohn’s Disease: by Province (2000) Bernstein AJGI 2005
Age-specific prevalence of UC: by Province (2000) Bernstein AJGI 2005
Projected prevalence of IBD in Canada in 2000 Population = 30,750,087 Prevalence of Crohn’s disease: 85,854 Prevalence of UC: 64,975 Total IBD: 150,829 ?2005: 170,000
MB rates similar to elsewhere in Canada • Low rates of Crohn’s disease in BC; 22% visible minorities • High rates of both Crohn’s & UC in Canada; ?North-South gradient
Published Estimates of the Incidence of Crohn’s Disease from Around the World 16 14 12 10 Incidence per 100,000 8 6 4 2 0 Ger Ital 78-87 Nor 83-86 Swe 78-87 Neth 88-92 Den 79-87 Spain 79-88 USA, Balt 77-79 USA, Minn 84-93 UK Cardiff 81-85 Manitoba 1988-96 N France 88-90
Published Estimates of the Incidence of Ulcerative Colitis from Around the World 16 14 12 10 8 Incidence per 100,000 6 4 2 0 Ger Nor 83-86 Ital 78-87 Den 79-87 Swe 78-87 Spain 79-88 Neth 88-92 USA,Minn 84-93 N France 88-90 UK Cardiff 81-85 Manitoba 88-96
Extraintestinal burden to the patient
Venous thrombosis in IBD There is approximately 1 DVT-PE / 200 patient-years Bernstein Thromb Hemostasis 2001
Venous thrombosis in IBD Bernstein Thromb Hemostasis 2001
Site-specific cancer IRR comparing cohorts with IBD to non-IBD cohorts matched by age, gender and postal area of residence, Manitoba, Canada, 1984-1997. Bernstein Cancer 2001
Other cancer risk rates Bernstein Cancer 2001
Age-specific rates of selected comorbidity in IBD and non-IBD hospitalized population, 1994/95-2002/03 Colon cancer population under 50 yrs Colon cancer population 50 yrs + older Rectal cancer population under 50 yrs Rectal cancer population 50 yrs + older * The rate is significantly higher in IBD compared to non-IBD cases, p<0.05.
Pulmonary emboli population under 50 yrs Pulmonary emboli population 50 yrs + older DVT population under 50 yrs DVT population 50 yrs + older
There is approximately 1 fracture/100 patient-years Bernstein Ann Intern Med 2000
Incidence rate ratios of All fractures comparing IBD to matched population-based non-IBD cohorts
A positive association between chronic inflammatory diseases with either form of IBD could suggest • common genetic predisposition • common etiologic triggers, • or possibly the triggering of one inflammatory condition secondary to Rx of a primary inflammatory condition. Am J Gastroenterol 2001 Gastroenterology 2005
Since the specificity of a single contact of any of these conditions is not known we analyzed the data for having at least 5 health system contacts. The precedent for this in Manitoba: • Ulcerative colitis • Crohn’s disease • Multiple sclerosis
Manitoba: 6.2% have a single extraintestinal disease (exclusive of arthritis) (0.3% have >1 extraintestinal disease) Sweden (UC): 6-12% (CD): <12% (includes abnormal liver tests)
Sociological burden *Health Care Utilization
Cross-Sectional StudyIBD vs. Controls: Outpatient Visits 2000-2001
Cross-Sectional StudyIBD vs. Controls: Hospitalizations 2000-2001 Longobardi CGH 2006
Longitudinal Study II15 Year Follow-up 1987 IBD Incidence Cohort Between 1987 and 2002 • 43% IBD cases have an IBD-specific overnight hospitalization • 47% CD • 21% UC • 30% IBD cases have an IBD-specific inpatient visit with a digestive disease surgery (excluding diagnostic endoscopy) • 41% CD • 16% UC Longobardi CGH 2006
Longitudinal Study II15 Year Follow-up 1987 IBD Incidence Cohort Readmission Rates Between 1987 and 2002 • 65% IBD cases admitted for an IBD-specific overnight hospitalization are readmitted • 70% CD • 53% UC • 39% IBD cases admitted for an IBD-specific inpatient visit with a digestive disease surgery (excluding diagnostic endoscopy) are readmitted • 39% CD • 39% UC
Longitudinal & cross sectional population-based studies in Manitoba
5 year cohort studyThe Manitoba IBD Cohort Study To describe predictors and patterns of outcomes among subjects diagnosed within 7 years • Psychological • Disease outcomes (phenotype) • Genotype • Health care utilization
Risk factor study Population-based case control study • Crohn’s disease and UC from U of M IBD Research Registry • Matched healthy controls from MH Registry • Non-affected sibs
Environmental Study • Assessing water sources to high and low incidence areas • Assessing biofilms, filters, and water for microbes
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