Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China.
J Gastroenterol Hepatol. 2019 Jan;34(1):124-131. doi: 10.1111/jgh.14377. Epub 2018 Jul 30.
Gastrointestinal (GI) diseases account for substantial morbidity, mortality, and health care utilization. This public hospital-based study assessed the incidence and time trend of hospitalization and mortality of major GI diseases over one decade.
We conducted an observational study using population-wide database managed by the Hong Kong Hospital Authority with a principal diagnosis of GI diseases defined by International Classification of Disease, 9th Revision, Clinical Modification coding. We measured age-standardized incidence of hospitalization, emergency admissions, multiple admissions, and in-hospital mortality from 2005 to 2014 using Poisson regression.
The annual incidence of hospitalization for GI diseases increased from 4713 to 5241 per 100 000 discharges (incidence rate ratio [IRR] = 1.004; 95% confidence interval [CI]: 1.003-1.005). GI infections and cancers showed the highest rates of hospitalization in 2014. Hospitalization for GI cancers (IRR = 1.014; 95% CI: 1.013-1.016) and non-infectious enterocolitis (IRR = 1.058; 95% CI: 1.055-1.061) increased, whereas peptic ulcer disease has decreased. Hospitalization for Crohn's disease showed the most significant rise (126%). Annual incidence of hospitalization for Clostridium difficile infections increased by fivefold (IRR = 1.221; 95% CI: 1.178-1.266), while a 66% reduction was observed for peptic ulcer bleeding (IRR = 0.894; 95% CI: 0.889-0.899). GI cancers had the highest in-hospital mortality rate in 2014, especially colorectal cancer and gastric cancer.
This study showed an increased hospitalization burden of GI cancers and Crohn's disease, and a reduction in overall mortality for GI diseases. These data provide insight into epidemiological changes of GI diseases in the 21st century and implications for hospital burden and need of resource re-allocation.
胃肠道（GI）疾病会导致大量的发病率、死亡率和医疗保健利用。本项基于公立医院的研究评估了 GI 疾病在十年间的住院和死亡率的发病率和时间趋势。
我们使用香港医院管理局管理的全人群数据库进行了一项观察性研究，使用国际疾病分类第 9 版临床修订版编码确定主要的 GI 疾病诊断。我们使用泊松回归来衡量 2005 年至 2014 年 GI 疾病的住院率、急诊入院率、多次入院率和院内死亡率的年龄标准化发病率。
GI 疾病的年住院率从 4713 例增加到 5241 例/每 100000 人出院（发病率比 [IRR] = 1.004；95%置信区间 [CI]：1.003-1.005）。2014 年，GI 感染和癌症的住院率最高。GI 癌症（IRR = 1.014；95%CI：1.013-1.016）和非传染性结肠炎（IRR = 1.058；95%CI：1.055-1.061）的住院率增加，而消化性溃疡疾病的住院率则下降。克罗恩病的住院率增长最为显著（126%）。艰难梭菌感染的年住院率增加了五倍（IRR = 1.221；95%CI：1.178-1.266），而消化性溃疡出血的住院率则降低了 66%（IRR = 0.894；95%CI：0.889-0.899）。2014 年，胃肠道癌症的住院死亡率最高，尤其是结直肠癌和胃癌。
本研究表明 GI 癌症和克罗恩病的住院负担增加，而 GI 疾病的总死亡率下降。这些数据为 21 世纪胃肠道疾病的流行病学变化提供了深入了解，并对医院负担和资源重新分配的需求产生影响。
