Trends in Epidemiology of Pediatric Inflammatory Bowel Disease in Canada: Distributed Network Analysis of Multiple Population-Based Provincial Health Administrative Databases

Eric I Benchimol, Charles N Bernstein, Alain Bitton, Matthew W Carroll, Harminder Singh, Anthony R Otley, Maria Vutcovici, Wael El-Matary, Geoffrey C Nguyen, Anne M Griffiths, David R Mack, Kevan Jacobson, Nassim Mojaverian, Divine Tanyingoh, Yunsong Cui, Zoann J Nugent, Janie Coulombe, Laura E Targownik, Jennifer L Jones, Desmond Leddin, Sanjay K Murthy, Gilaad G Kaplan, Eric I Benchimol, Charles N Bernstein, Alain Bitton, Matthew W Carroll, Harminder Singh, Anthony R Otley, Maria Vutcovici, Wael El-Matary, Geoffrey C Nguyen, Anne M Griffiths, David R Mack, Kevan Jacobson, Nassim Mojaverian, Divine Tanyingoh, Yunsong Cui, Zoann J Nugent, Janie Coulombe, Laura E Targownik, Jennifer L Jones, Desmond Leddin, Sanjay K Murthy, Gilaad G Kaplan

Abstract

Objectives: The incidence of pediatric-onset inflammatory bowel disease (IBD) is increasing worldwide. We used population-based health administrative data to determine national Canadian IBD incidence, prevalence, and trends over time of childhood-onset IBD.

Methods: We identified children <16 years (y) diagnosed with IBD 1999-2010 from health administrative data in five provinces (Alberta, Manitoba, Nova Scotia, Ontario, Quebec), comprising 79.2% of the Canadian population. Standardized incidence and prevalence were calculated per 100,000 children. Annual percentage change (APC) in incidence and prevalence were determined using Poisson regression analysis. Provincial estimates were meta-analyzed using random-effects models to produce national estimates.

Results: 5,214 incident cases were diagnosed during the study period (3,462 Crohn's disease, 1,382 ulcerative colitis, 279 type unclassifiable). The incidence in Canada was 9.68 (95% CI 9.11 to 10.25) per 100,000 children. Incidence was similar amongst most provinces, but higher in Nova Scotia. APC in incidence did not significantly change over the study period in the overall cohort (+2.06%, 95% CI -0.64% to +4.76%). However, incidence significantly increased in children aged 0-5y (+7.19%, 95% +2.82% to +11.56%). Prevalence at the end of the study period in Canada was 38.25 (95% CI 35.78 to 40.73) per 100,000 children. Prevalence increased significantly over time, APC +4.56% (95% CI +3.71% to +5.42%).

Conclusions: Canada has amongst the highest incidence of childhood-onset IBD in the world. Prevalence significantly increased over time. Incidence was not statistically changed with the exception of a rapid increase in incidence in the youngest group of children.

Conflict of interest statement

Guarantor of the article: Eric I. Benchimol, MD, PhD, FRCPC.

Specific author contributions: Eric I. Benchimol: study conception and design; analysis and interpretation of data; drafting of manuscript; statistical analysis; obtained funding. Charles N. Bernstein: study conception and design; analysis and interpretation of data; critical revision of the manuscript; statistical analysis; obtained funding. Alain Bitton: study conception and design; analysis and interpretation of data; critical revision of the manuscript; statistical analysis; obtained funding. Matthew W. Carroll: study conception and design; analysis and interpretation of data; critical revision of the manuscript; statistical analysis; obtained funding. Harminder Singh: study conception and design; analysis and interpretation of data; critical revision of the manuscript; statistical analysis; obtained funding. Anthony R. Otley: study conception and design; analysis and interpretation of data; critical revision of the manuscript; statistical analysis; obtained funding. Maria Vutcovici: analysis and interpretation of data; critical revision of the manuscript; statistical analysis; obtained funding. Wael El-Matary: analysis and interpretation of data; critical revision of the manuscript; statistical analysis; obtained funding. Geoffrey C. Nguyen: study conception and design; analysis and interpretation of data; critical revision of the manuscript; statistical analysis; obtained funding. Anne M. Griffiths: analysis and interpretation of data; critical revision of the manuscript; obtained funding. David R. Mack: Analysis and interpretation of data; critical revision of the manuscript; obtained funding. Kevan Jacobson: analysis and interpretation of data; critical revision of the manuscript; obtained funding. Nassim Mojaverian: analysis and interpretation of results; statistical analysis; technical support; critical revision of the manuscript for important Divine Tanyingoh: analysis and interpretation of results; statistical analysis; technical support; critical revision of the manuscript for important. Yunsong Cui: analysis and interpretation of results; statistical analysis; technical support; critical revision of the manuscript for important. Zoann Nugent: analysis and interpretation of results; statistical analysis; technical support; critical revision of the manuscript for important. Janie Coulombe: analysis and interpretation of results; statistical analysis; technical support; critical revision of the manuscript for important. Laura E. Targownik: analysis and interpretation of data; critical revision of the manuscript; obtained funding. Jennifer L. Jones: analysis and interpretation of data; critical revision of the manuscript; obtained funding. Desmond Leddin: analysis and interpretation of data; critical revision of the manuscript; obtained funding. Sanjay K. Murthy: analysis and interpretation of data; critical revision of the manuscript; obtained funding. Gilaad G. Kaplan: study conception and design; analysis and interpretation of data; critical revision of the manuscript; statistical analysis; obtained funding.

Financial Support: This research was funded by operating grants from the Crohn’s and Colitis Canada and the Ontario Research Fund: Early Researcher Awards. CanGIEC is funded by the Canadian Institutes of Health Research (CIHR) Foundation Scheme. This study also received financial support from the Canadian Children IBD Network: A Joint Partnership of CIHR and the CH.I.L.D. Foundation. Eric Benchimol and Geoffrey Nguyen were supported by New Investigator Awards from CIHR, Crohn’s and Colitis Canada, and the Canadian Association of Gastroenterology. Charles Bernstein is supported in part by the Bingham Chair in Gastroenterology.

Potential competing interests: The following investigators are also investigators or collaborators in the Canadian Children IBD Network: A Joint Partnership of CIHR and the CH.I.L.D. Foundation, which provided funding for this study: Eric I. Benchimol, Matthew W. Carroll, Anthony R. Otley, Wael El-Matary, Anne M. Griffiths, David R. Mack, Kevan Jacobson, Gilaad G. Kaplan. The following authors served on the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada, which provided funding for this study: Eric I. Benchimol, Charles N. Bernstein, Anthony R. Otley, Gilaad G. Kaplan.

Figures

Figure 1
Figure 1
(a) Incidence of IBD (1999–2010) and (b) prevalence of IBD in the final year of available data in each province of Canada.
Figure 2
Figure 2
Annual standardized incidence (per 100,000 population) of (a) IBD, (b) Crohn’s disease, and (c) ulcerative colitis in Canada (1999–2010).
Figure 3
Figure 3
Annual percentage change in incidence of (a) IBD, (b) CD, and (c) UC by age group. Meta-analysis was conducted to combine provincial estimates. I2 was calculated to determine heterogeneity in provincial results.
Figure 4
Figure 4
Annual percentage change in (a) incidence and (b) prevalence represented on a map of Canada. *P<0.05 for increased incidence over time; #P<0.05 for decreased incidence over time.
Figure 5
Figure 5
Annual standardized prevalence (per 100,000 population) of (a) IBD, (b) Crohn’s disease, and (c) ulcerative colitis in Canada on July 1 of the final year of the provincial cohort (2008 for Nova Scotia and Quebec, 2010 for Alberta, Manitoba, and Ontario).
Figure 6
Figure 6
Annual percentage change in prevalence of IBD by age group. Meta-analysis was conducted to combine provincial estimates. I2 was calculated to determine heterogeneity in provincial results.

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Source: PubMed

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