Paradoxical Trends in Hospitalization Rates for the Inflammatory Bowel Diseases Between the Western World and Newly Industrialized Countries: A Study of the Organization for Economic Cooperation and Development (OECD)

Introduction: Hospitalization rates for the inflammatory bowel diseases (IBD) may be decreasing in the Western world due to advances in medical management. In contrast, newly industrialized countries in Asia and Southern America may have increasing hospitalization rates due to rapidly rising incidence. We evaluated changing rates in hospitalization for IBD in countries belonging to the Organisation for Economic Co-operation and Development (OECD). Methods: The OECD database contained IBD related hospital discharges for 34 countries from 1990 to 2015. Hospitalization rates were expressed as annual rates per 100,000 persons. Average hospitalization rates were standardized for the period 2010 to 2014. Joinpoint regression models were used to calculate the average annual percent change (AAPC) in the rate of hospitalization for each country in 1990 to 2015. Choropleth maps were created to display the differences in hospitalization rates and AAPCs. Results: Hospitalization rates related to IBD from OECD countries are presented in Table 1 and Figure 1. The median hospitalization rate was 31.2 with an interquartile range (IQR) of 23.7 to 47.4 per 100,000. Average hospitalization rates from 2010 to 2014 were highest in Northern America (e.g. US: 33.9 per 100,000), Northern Europe (e.g. Denmark: 63.6 per 100,000), Eastern Europe (e.g. Hungary: 50.4 per 100,000), Western Europe (e.g. Austria: 73.0 per 100,000), and Oceania (e.g. Australia: 31.2 per 100,000). In Europe, Northern America, and Oceania, 50% of countries have decreasing or stable hospitalization rates (Table 1, Figure 1-3). In contrast, countries from Asia and Southern America have the lowest hospitalization rates, yet the highest rise in AAPC. For example, Turkey has a hospitalization rate of 10.0 per 100,000 and an AAPC of 9.2% (95% CI: 5.9, 12.5), while Chile has a hospitalization rate of 8.4 per 100,000 and an AAPC of 5.2% (95% CI: 4.3, 6.2) (Table 1, Figure 1-3).Figure: Global map of the average hospitalization rates for IBD from 2010 to 2014 in 34 Organization for Economic Co-Operation and Development countries, stratified by quartile.Figure: Global map of the average annual percent change in hospitalization rates for IBD in 32 Organization for Economic Co-Operation and Development countries from time periods ranging between 1990 and 2015, stratified by quartile.Table: Table. Trends in hospital discharges for Crohn's disease and ulcerative colitis in OECD countriesConclusion: Highly industrialized countries of the Western world have high rates of hospitalization; however, the rate of hospitalization appears to be stabilizing or decreasing in many Western countries. In contrast, newly industrialized countries in Asia and Southern America have rapidly rising hospitalization rates, which parallel the known rise in incidence of IBD outside the Western world.

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