非常早发性炎症性肠病的发病率、结局和医疗服务负担。

Incidence, outcomes, and health services burden of very early onset inflammatory bowel disease.

机构信息

Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.

出版信息

Gastroenterology. 2014 Oct;147(4):803-813.e7; quiz e14-5. doi: 10.1053/j.gastro.2014.06.023. Epub 2014 Jun 18.

DOI:10.1053/j.gastro.2014.06.023

PMID:24951840

Abstract

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. IBD-related 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.

摘要

背景与目的

巴黎儿科改良蒙特利尔分类将极早发型炎症性肠病（VEO-IBD）定义为一种与年长儿童不同的 IBD 形式。我们比较了 VEO-IBD 与年长儿童 IBD 的发病率和结局。

方法

我们对加拿大安大略省所有在 1994 年至 2009 年期间被诊断为 IBD 的儿童进行了基于人群的回顾性队列研究。使用泊松回归计算标准化发病率的趋势。我们比较了年龄小于 6 岁、6-9.9 岁和大于 10 岁时被诊断为 IBD 的儿童的门诊和急诊就诊、住院和手术情况。多变量模型调整了收入，并按性别分层。

结果

IBD 的发病率从 1994 年的每 100,000 名儿童 9.4 例（95%可信区间 [CI]，8.2-10.8/100,000 名儿童）增加到 2009 年的每 100,000 名儿童 13.2 例（95% CI，11.9-14.6/100,000 名儿童）（P<0.0001）。年龄小于 6 岁和 6-9.9 岁的儿童发病率每年分别增加 7.4%和 2.2%，而年龄大于 10 岁的儿童发病率每年增加 2.2%。与年龄大于 10 岁的儿童相比，年龄小于 6 岁的儿童 IBD 相关的门诊就诊次数较少（女性患者比值比为 0.67；95%CI，0.58-0.78；男性患者比值比为 0.86；95%CI，0.75-0.98）。年龄小于 6 岁的儿童住院风险比（HR）较低（女性 HR，0.70；95%CI，0.56-0.87；男性 HR，1.12；95%CI，0.94-1.33），手术风险比（HR）较低（女性患者 HR，0.35；95%CI，0.16-0.78；男性患者 HR，0.59；95%CI，0.34-0.99）。年龄小于 6 岁的克罗恩病患儿 HR 为 0.88（95%CI，0.47-1.63），男性为 0.42（95%CI，0.21-0.85）。6-9.9 岁与 10 岁或以上儿童的住院或手术率无差异。