Trends in the epidemiology of inflammatory bowel disease in Colombia by demographics and region using a nationally representative claims database and characterization of inflammatory bowel disease phenotype in a case series of Colombian patients.
Trends in the epidemiology of inflammatory bowel disease in Colombia by demographics and region using a nationally representative claims database and characterization of inflammatory bowel disease phenotype in a case series of Colombian patients.
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DOI：
10.1097/md.0000000000024729
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发表时间：
2021-02-19
期刊：
影响因子：
1.6
通讯作者：
Damas OM
中科院分区：
文献类型：
--
作者：
Juliao-Baños F;Kock J;Arrubla M;Calixto O;Camargo J;Cruz L;Hurtado J;Clavijo A;Donado J;Schwartz S;Abreu MT;Damas OM
炎症性肠病（IBD）的发病率在拉丁美洲呈上升趋势。本研究的目的是通过人口统计学、地区、城市化来研究哥伦比亚IBD的流行病学趋势，并在一个大型的特征明确的哥伦比亚队列中描述IBD表型。我们使用了一个包含3300万成年人（占哥伦比亚人口的97.6%）的国家数据库，以获得IBD的流行病学趋势，使用国际疾病分类10编码溃疡性结肠炎（UC）和克罗恩病（CD）成人。我们计算了2010-2017年UC和CD的发病率和患病率，并按城市化、人口统计学和地区检查了流行病学趋势。然后，我们检查了IBD表型（使用蒙特利尔分类），IBD相关手术的患病率，以及2001年至2017年期间在哥伦比亚麦德林地区IBD诊所就诊的成人患者的IBD药物类型。UC的发病率从2010年的5.59/100，000增加到2017年的6.3/100，000（相对风险[RR] 1.12，置信区间（CI）（1.09-1.18），P <.0001）。 虽然CD发病率没有增加，但在此期间患病率增加。安第斯山脉地区IBD发病率最高（2017年为5.56/10万）。IBD在哥伦比亚农村地区较少见（RR= 0.95，CI（0.92-0.97），p <0.01）。 即使在调整了年龄和诊断年份后，女性IBD的风险也增加（RR 1.06（1.02-1.08），P =.0003）。 IBD风险最高发生在40至59岁的患者中。 在临床队列中，有649例IBD患者：73.7%的UC和24.5%的CD。CD的平均诊断年龄为41.0岁，UC为39.9岁。UC患者大多发生全结肠炎（43%）。CD患者大多发生回结肠疾病，超过三分之一的患者具有炎性非瘘管化表型（37.7%）。共有16.7%的CD患者有肛周疾病。CD患者比UC患者接受更多的生物制剂（比值比：3.20，95% CI 2.19-4.69 P <.001）。 使用国家代表性样本和区域诊所队列，我们发现UC在哥伦比亚更常见，并且在城市地区呈上升趋势;与西方国家相比，尤其是发生在老年队列中。未来的研究有必要了解解释这种上升的不断变化的环境因素。
The incidence of inflammatory bowel disease (IBD) is on the rise in Latin America. The aims of this study were to examine epidemiologic trends of IBD in Colombia by demographics, region, urbanicity, and to describe the IBD phenotype in a large well-characterized Colombian cohort. We used a national database of 33 million adults encompassing 97.6% of the Colombian population in order to obtain epidemiologic trends of IBD using International Classification of Diseases 10codes for adults with ulcerative colitis (UC) and Crohn disease (CD). We calculated the incidence and prevalence of UC and CD from 2010–2017 and examined epidemiologic trends by urbanicity, demographics, and region. We then examined the IBD phenotype (using Montreal Classification), prevalence of IBD-related surgeries, and types of IBD-medications prescribed to adult patients attending a regional IBD clinic in Medellin, Colombia between 2001 and 2017. The incidence of UC increased from 5.59/100,000 in 2010 to 6.3/100,000 in 2017 (relative risk [RR] 1.12, confidence interval (CI) (1.09–1.18), P < .0001). While CD incidence did not increase, the prevalence increased within this period. The Andes region had the highest incidence of IBD (5.56/100,000 in 2017). IBD was seen less in rural regions in Colombia (RR=.95, CI (0.92–0.97), p < .01). An increased risk of IBD was present in women, even after adjusting for age and diagnosis year (RR 1.06 (1.02–1.08), P = .0003). The highest IBD risk occurred in patients 40 to 59 years of age. In the clinic cohort, there were 649 IBD patients: 73.7% UC and 24.5% CD. Mean age of diagnosis in CD was 41.0 years and 39.9 years in UC. UC patients developed mostly pancolitis (43%). CD patients developed mostly ileocolonic disease and greater than a third of patients had an inflammatory, non-fistulizing phenotype (37.7%). A total of 16.7% of CD patients had perianal disease. CD patients received more biologics than UC patients (odds ratio: 3.20, 95% CI 2.19–4.69 P < .001). Using both a national representative sample and a regional clinic cohort, we find that UC is more common in Colombia and is on the rise in urban regions; especially occurring in an older age cohort when compared to Western countries. Future studies are warranted to understand evolving environmental factors explaining this rise.