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The Burden of IBD Charles N. Bernstein, MD University of Manitoba

The Burden of IBD Charles N. Bernstein, MD University of Manitoba IBD Clinical and Research Centre Winnipeg, Manitoba, Canada. IBD Database Construction. Persons with at least one IBD contact, 1984-1995 (n=10,541). Apply case definitions to entire health database. Exclude if <3 contacts

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The Burden of IBD Charles N. Bernstein, MD University of Manitoba

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  1. The Burden of IBD Charles N. Bernstein, MD University of Manitoba IBD Clinical and Research Centre Winnipeg, Manitoba, Canada

  2. IBD Database Construction Persons with at least one IBD contact, 1984-1995 (n=10,541) Apply case definitions to entire health database Exclude if <3 contacts beginning prior to 1993 (n=5,359) Evaluate “case definitions” versus random charts (n=448) Distribute consent and demographic questionnaire to current residents. (n=4,514) Optimize “case definitions” versus self-reported diagnosis 60% “Crohn’s disease” (n=1,230) “Ulcerative colitis” (n=1,222) Analyze medical contact patterns for questionnaire respondents. (n=2,725) “No IBD” (n=273) Bernstein Am J Epidemiol 1999

  3. Case Definitions: Crohn’s Disease and UC • At least 5 separate hospital/physician contacts with a diagnosis between 1984 and 1995. OR • If registered with Manitoba Health for <2 years, at least 3 separate hospital/physician contacts with a diagnosis. • If both CD and UC criteria were met, then the majority diagnosis of the most recent 9 contacts was used. • Diagnosis date is the first hospital/physician contact (applied only to first contacts beginning in 1988 or later).

  4. Time Trends

  5. Crohn’s disease prevalence and incidence, Manitoba, 1990 - 2001, cases/100,000, age standardized to the 1996 Manitoba population

  6. UC prevalence and incidence, Manitoba, 1990 - 2001, cases/100,000 age standardized to the 1996 Manitoba population

  7. Annual Age-Adjusted Prevalence of CD and UC, by First Nation (FN) Status, Manitoba. 250 209 Non-FN CD 200 176 Non-FN UC 150 Prevalence per 100,000 100 57 FN UC 50 14 FN CD 0 1987 1988 1989 1990 1991 1992 1993 1994 Blanchard Am J Epidemiol 2001

  8. BC AB SK MB NS

  9. Age-specific incidence of Crohn’s Disease: by Province Bernstein AJGI 2005

  10. Age-specific incidence of UC: by Province (1998-2000) Bernstein AJGI 2005

  11. Age-specific prevalence of Crohn’s Disease: by Province (2000) Bernstein AJGI 2005

  12. Age-specific prevalence of UC: by Province (2000) Bernstein AJGI 2005

  13. Projected prevalence of IBD in Canada in 2000 Population = 30,750,087 Prevalence of Crohn’s disease: 85,854 Prevalence of UC: 64,975 Total IBD: 150,829 ?2005: 170,000

  14. MB rates similar to elsewhere in Canada • Low rates of Crohn’s disease in BC; 22% visible minorities • High rates of both Crohn’s & UC in Canada; ?North-South gradient

  15. Place - Geographic Distribution

  16. Published Estimates of the Incidence of Crohn’s Disease from Around the World 16 14 12 10 Incidence per 100,000 8 6 4 2 0 Ger Ital 78-87 Nor 83-86 Swe 78-87 Neth 88-92 Den 79-87 Spain 79-88 USA, Balt 77-79 USA, Minn 84-93 UK Cardiff 81-85 Manitoba 1988-96 N France 88-90

  17. Published Estimates of the Incidence of Ulcerative Colitis from Around the World 16 14 12 10 8 Incidence per 100,000 6 4 2 0 Ger Nor 83-86 Ital 78-87 Den 79-87 Swe 78-87 Spain 79-88 Neth 88-92 USA,Minn 84-93 N France 88-90 UK Cardiff 81-85 Manitoba 88-96

  18. CD Incidence, 1990 - 2001Cases/10,000, Smoothed

  19. An Ecological StudyGreen Am J Epidemiol 2006

  20. Extraintestinal burden to the patient

  21. Venous thrombosis in IBD There is approximately 1 DVT-PE / 200 patient-years Bernstein Thromb Hemostasis 2001

  22. Venous thrombosis in IBD Bernstein Thromb Hemostasis 2001

  23. Site-specific cancer IRR comparing cohorts with IBD to non-IBD cohorts matched by age, gender and postal area of residence, Manitoba, Canada, 1984-1997. Bernstein Cancer 2001

  24. Other cancer risk rates Bernstein Cancer 2001

  25. Age-specific rates of selected comorbidity in IBD and non-IBD hospitalized population, 1994/95-2002/03 Colon cancer population under 50 yrs Colon cancer population 50 yrs + older Rectal cancer population under 50 yrs Rectal cancer population 50 yrs + older * The rate is significantly higher in IBD compared to non-IBD cases, p<0.05.

  26. Pulmonary emboli population under 50 yrs Pulmonary emboli population 50 yrs + older DVT population under 50 yrs DVT population 50 yrs + older

  27. There is approximately 1 fracture/100 patient-years Bernstein Ann Intern Med 2000

  28. Incidence rate ratios of All fractures comparing IBD to matched population-based non-IBD cohorts

  29. A positive association between chronic inflammatory diseases with either form of IBD could suggest • common genetic predisposition • common etiologic triggers, • or possibly the triggering of one inflammatory condition secondary to Rx of a primary inflammatory condition. Am J Gastroenterol 2001 Gastroenterology 2005

  30. Since the specificity of a single contact of any of these conditions is not known we analyzed the data for having at least 5 health system contacts. The precedent for this in Manitoba: • Ulcerative colitis • Crohn’s disease • Multiple sclerosis

  31. Manitoba: 6.2% have a single extraintestinal disease (exclusive of arthritis) (0.3% have >1 extraintestinal disease) Sweden (UC): 6-12% (CD): <12% (includes abnormal liver tests)

  32. Period Prevalence of comorbid diagnoses in UC

  33. Period Prevalence of comorbid diagnoses in CD

  34. Sociological burden *Health Care Utilization

  35. Cross-Sectional StudyIBD vs. Controls: Outpatient Visits 2000-2001

  36. Cross-Sectional StudyIBD vs. Controls: Hospitalizations 2000-2001 Longobardi CGH 2006

  37. Longitudinal Study II15 Year Follow-up 1987 IBD Incidence Cohort Between 1987 and 2002 • 43% IBD cases have an IBD-specific overnight hospitalization • 47% CD • 21% UC • 30% IBD cases have an IBD-specific inpatient visit with a digestive disease surgery (excluding diagnostic endoscopy) • 41% CD • 16% UC Longobardi CGH 2006

  38. Longitudinal Study II15 Year Follow-up 1987 IBD Incidence Cohort Readmission Rates Between 1987 and 2002 • 65% IBD cases admitted for an IBD-specific overnight hospitalization are readmitted • 70% CD • 53% UC • 39% IBD cases admitted for an IBD-specific inpatient visit with a digestive disease surgery (excluding diagnostic endoscopy) are readmitted • 39% CD • 39% UC

  39. Longitudinal & cross sectional population-based studies in Manitoba

  40. 5 year cohort studyThe Manitoba IBD Cohort Study To describe predictors and patterns of outcomes among subjects diagnosed within 7 years • Psychological • Disease outcomes (phenotype) • Genotype • Health care utilization

  41. Risk factor study Population-based case control study • Crohn’s disease and UC from U of M IBD Research Registry • Matched healthy controls from MH Registry • Non-affected sibs

  42. Environmental Study • Assessing water sources to high and low incidence areas • Assessing biofilms, filters, and water for microbes

  43. Health Sciences: The Organizational Unit of Application Molecular & Submolecular Particles Cells Organs Individuals Families Communities Societies Epidemiology Clinical Research Pathology, Physiology Cell Biology Molecular Biology

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