Incidence, Outcomes, and Health Services Burden of Very Early Onset Inflammatory Bowel Disease
Incidence, Outcomes, and Health Services Burden of Very Early Onset Inflammatory Bowel Disease
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DOI：
10.1053/j.gastro.2014.06.023
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发表时间：
2014-10-01
期刊：
影响因子：
29.4
通讯作者：
Muise, Aleixo M.
中科院分区：
文献类型：
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作者：
Benchimol, Eric I.;Mack, David R.;Muise, Aleixo M.
背景与目的：巴黎儿科修订版蒙特利尔分类将极早发型炎症性肠病（VEO-IBD）定义为不同于大龄儿童的IBD形式。我们比较了年龄较大儿童中VEO-IBD与IBD的发病率和结局。方法：我们对1994年至2009年在加拿大安大略诊断为IBD的所有儿童进行了一项基于人群的回顾性队列研究。采用Poisson回归计算标准化发病率的趋势。我们比较了6岁以下、6-9.9岁和10岁以上诊断为IBD的儿童的门诊和急诊就诊、住院和手术情况。多变量模型根据收入进行调整，并按性别分层。研究结果：IBD的发病率从1994年的9.4/100，000儿童（95%置信区间[CI]，8.2-10.8/100，000儿童）增加到2009年的13.2/100，000儿童（95% CI，11.9-14.6/100，000儿童）（P < .0001）。6岁以下和6-9.9岁儿童的发病率每年增加7.4%，10岁以上儿童的发病率每年增加2.2%。≥ 10岁儿童IBD相关门诊就诊频率较低< 6 years old than >（女性患者的比值比为0.67; 95%CI为0.58-0.78;男性患者的比值比为0.86; 95%CI为0.75-0.98）。< 6岁儿童的住院风险比[HR]（女性HR，0.70; 95% CI，0.56-0.87;男性HR，1.12; 95% CI，0.94-1.33）低于年龄较大的儿童。在< 6岁的克罗恩病儿童中，女性患者手术的HR为0.35（95% CI，0.16-0.78），男性患者为0.59（95% CI，0.34-0.99）。6岁以下儿童溃疡性结肠炎女性患者的HR为0.88（95%CI，0.47-1.63），男性患者的HR为0.42（95%CI，0.21-0.85）。6-9.9岁儿童与>= 10岁儿童的住院率或手术率没有差异。结论：基于一项回顾性队列研究，从1994年到2009年，VEO-IBD的发病率增加。6岁之前被诊断患有IBD的儿童使用的卫生服务较少，手术率低于10岁或10岁以上被诊断的儿童。
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. IBDrelated 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.