The Changing Pattern of Crohn's Disease Incidence
The Changing Pattern of Crohn's Disease Incidence
Background Crohn's disease incidence rates have stabilised in industrialised countries since the 1980s. Conversely, a continuing increase in childhood-onset Crohn's disease incidence has been reported.
Aim To confirm trends in inflammatory bowel disease (IBD) incidence in northern France over an extended time period (1988–2007) with a focus on childhood-onset Crohn's disease.
Methods The IBD patients recorded in the EPIMAD registry between 1988 and 2007 were included. Standardised incidence rates were calculated for Crohn's disease and ulcerative colitis in the entire population, and separately according to age. Evolution of phenotypes at diagnosis was also studied.
Results A total of 12 084 incident IBD cases (7428 Crohn's disease and 4656 ulcerative colitis) were recorded. Crohn's disease incidence rates increased from 5.2 cases/100 000 persons in 1988–1990 to 6.7 in 2006–2007 (+29%), stabilising after a peak at 7.1 in 1997–1999. Crohn's disease incidence rates in the 10–19-year age category increased by 71%, from 6.5 (1988–1990) to 11.1 (2006–2007). The frequency of initial ileo-colonic localisation increased from 52.9% in 1988–1990 to 68.6% in 2006–2007 (P < 0.0001). Ulcerative colitis incidence rates decreased during the same period.
Conclusions From 1988 to 2007, Crohn's disease incidence increased by 29% in northern France and by 71% in the 10–19-year-old age group. Consequently, studies on Crohn's disease risk factors should focus on the population under 20 years of age.
Inflammatory bowel diseases (IBD) represent a major burden for developed countries. It has been estimated that as many as 1.4 million persons may be afflicted with IBD in the US and Canada, and 2.2 million in Europe Crohn's disease (CD) and ulcerative colitis (UC) are the major IBD that challenge gastroenterologists. Although significant advances have been made towards a better understanding of the pathophysiology of IBD, their aetiology remains unclear. Epidemiological studies of geographic and temporal variations in IBD provide important information on the natural history, health care burden and causal mechanisms of the disease. In particular, population-based epidemiological studies are more likely to reflect the true spectrum of illness than studies performed on patients seen at referral centres. Indeed, epidemiological studies have shown a continuing increase in or stabilisation of CD incidence rates in developed countries over the past five decades. In contrast, several studies have described a continuing increase in incidence rates of CD in children and adolescents, suggesting that ongoing risk factors may exist in these populations. Nevertheless, these changes in the incidence of juvenile-onset CD remain subject to debate and need to be confirmed in larger population-based registries. The EPIMAD study records all incident cases of IBD since 1988 in northern France. Previously published studies covering the 1988–1999 period reported a significant increase in incidences rates of CD in the overall population, as well as a nonsignificant increase in the paediatric population. The aim of the present study was therefore to conduct an updated analysis of the evolution of incidence rates and digestive sites of CD and UC for the 1988–2007 periods in a large population registry which included infants and young adults.
Abstract and Introduction
Abstract
Background Crohn's disease incidence rates have stabilised in industrialised countries since the 1980s. Conversely, a continuing increase in childhood-onset Crohn's disease incidence has been reported.
Aim To confirm trends in inflammatory bowel disease (IBD) incidence in northern France over an extended time period (1988–2007) with a focus on childhood-onset Crohn's disease.
Methods The IBD patients recorded in the EPIMAD registry between 1988 and 2007 were included. Standardised incidence rates were calculated for Crohn's disease and ulcerative colitis in the entire population, and separately according to age. Evolution of phenotypes at diagnosis was also studied.
Results A total of 12 084 incident IBD cases (7428 Crohn's disease and 4656 ulcerative colitis) were recorded. Crohn's disease incidence rates increased from 5.2 cases/100 000 persons in 1988–1990 to 6.7 in 2006–2007 (+29%), stabilising after a peak at 7.1 in 1997–1999. Crohn's disease incidence rates in the 10–19-year age category increased by 71%, from 6.5 (1988–1990) to 11.1 (2006–2007). The frequency of initial ileo-colonic localisation increased from 52.9% in 1988–1990 to 68.6% in 2006–2007 (P < 0.0001). Ulcerative colitis incidence rates decreased during the same period.
Conclusions From 1988 to 2007, Crohn's disease incidence increased by 29% in northern France and by 71% in the 10–19-year-old age group. Consequently, studies on Crohn's disease risk factors should focus on the population under 20 years of age.
Introduction
Inflammatory bowel diseases (IBD) represent a major burden for developed countries. It has been estimated that as many as 1.4 million persons may be afflicted with IBD in the US and Canada, and 2.2 million in Europe Crohn's disease (CD) and ulcerative colitis (UC) are the major IBD that challenge gastroenterologists. Although significant advances have been made towards a better understanding of the pathophysiology of IBD, their aetiology remains unclear. Epidemiological studies of geographic and temporal variations in IBD provide important information on the natural history, health care burden and causal mechanisms of the disease. In particular, population-based epidemiological studies are more likely to reflect the true spectrum of illness than studies performed on patients seen at referral centres. Indeed, epidemiological studies have shown a continuing increase in or stabilisation of CD incidence rates in developed countries over the past five decades. In contrast, several studies have described a continuing increase in incidence rates of CD in children and adolescents, suggesting that ongoing risk factors may exist in these populations. Nevertheless, these changes in the incidence of juvenile-onset CD remain subject to debate and need to be confirmed in larger population-based registries. The EPIMAD study records all incident cases of IBD since 1988 in northern France. Previously published studies covering the 1988–1999 period reported a significant increase in incidences rates of CD in the overall population, as well as a nonsignificant increase in the paediatric population. The aim of the present study was therefore to conduct an updated analysis of the evolution of incidence rates and digestive sites of CD and UC for the 1988–2007 periods in a large population registry which included infants and young adults.
Source...