Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02199, USA.
Dig Dis Sci. 2023 Apr;68(4):1226-1236. doi: 10.1007/s10620-022-07675-6. Epub 2022 Aug 31.
To establish the epidemiology and patterns of care of Crohn's Disease in low- and lower-middle-income countries.
A cross-sectional survey of gastroenterology providers in countries where the world's poorest billion live was conducted to learn more about the state of diagnostic and treatment capacity for Crohn's. Quantitative data were analyzed in R and Excel.
A total of 46 survey responses from 15 countries were received, giving a response rate of 54.8%. All responses collected were from providers practicing in Africa and South Asia. The mean number of patients with Crohn's cared for in the last year was 89.5 overall but ranged from 0 reported at one facility in Rwanda to 1000 reported at two different facilities in India. Overall, Crohn's disease made up 20.6% of the inflammatory bowel disease diagnoses reported by survey respondents, with Africa exhibiting a larger proportion of Crohn's compared to ulcerative colitis than Asia. Most providers reported that patients with Crohn's have symptoms for 6-24 months prior to diagnosis and that 26-50% of their patients live in rural areas. The most reported diagnostic challenges are differentiating between Crohn's and intestinal tuberculosis, poor disease awareness, and lack of trained pathologists. The most widely reported challenge in managing Crohn's disease is patients' inability to afford biologics, reported by 65% of providers.
Our study suggests there may be a greater burden of Crohn's disease in low- and lower-middle-income countries than is indicated in prior literature. Respondents reported many challenges in diagnosing and treating Crohn's disease.
了解低收入和中低收入国家克罗恩病的流行病学和治疗模式。
对世界上最贫困的 10 亿人所在国家的胃肠病学医生进行了横断面调查，以了解克罗恩病的诊断和治疗能力状况。在 R 和 Excel 中对定量数据进行了分析。
共收到来自 15 个国家的 46 份调查回复，回复率为 54.8%。所有回复均来自非洲和南亚的执业医生。过去一年中，每位医生平均诊治的克罗恩病患者为 89.5 例，但范围从卢旺达一家机构报告的 0 例到印度两家机构报告的 1000 例。总体而言，克罗恩病占调查对象报告的炎症性肠病诊断的 20.6%，非洲的克罗恩病比例高于溃疡性结肠炎，而亚洲则相反。大多数医生报告称，克罗恩病患者在确诊前有 6-24 个月的症状，且 26-50%的患者居住在农村地区。最常报告的诊断挑战是区分克罗恩病和肠结核、疾病认知度低以及缺乏训练有素的病理学家。最常报告的克罗恩病管理挑战是患者无法负担生物制剂，65%的医生报告了这一挑战。
我们的研究表明，低收入和中低收入国家的克罗恩病负担可能比之前文献所表明的更重。调查对象报告了在诊断和治疗克罗恩病方面存在诸多挑战。
