Hospitalizations for Crohn’s Disease — United States, 2003–2013

Abstract

In 2009, an estimated 565,000 Americans had Crohn's dis-ease (1), an inflammatory bowel disorder that can affect any part of the gastrointestinal tract. Symptoms include persistent diarrhea, abdominal cramps and pain, constipation leading to bowel obstruction, and rectal bleeding.* Symptoms sometimes intensify in severity and require hospitalization and surgeries of the small intestine, colon, or rectum (2). Hospital dis-charge data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) were used to estimate U.S. hospitalizations for Crohn's disease as both the first-listed and any-listed discharge diagnosis and com-mon surgical procedures during hospitalizations with Crohn's disease as first-listed diagnosis from 2003 to 2013, the most recent decade of data. Despite new therapies that were expected to improve remission and reduce hospitalizations, estimated numbers (and age-adjusted rates per 100,000 U.S. popula-tion) of hospitalizations for Crohn's disease as the first-listed diagnosis did not change significantly from 2003 to 2013. The proportion of these hospitalizations during which small bowel resection was performed decreased from 4.9% in 2003 to 3.9% in 2013 (p<0.05); however, colorectal resection and fistula repair rates remained stable. Hospital stays for any-listed Crohn's disease increased from >120,000 (44.2 per 100,000) in 2003 to >196,000 (59.7 per 100,000) in 2013 (p<0.05). Patient education initiatives should focus on increasing aware-ness of exacerbating factors and medication compliance to prevent hospitalizations. NIS hospital discharge data, which were obtained from the Agency for Healthcare Research and Quality (AHRQ), represent an annual stratified sample of 7–8 million hospital records collected by 37–44 participating states from approximately 20% of U.S. community hospitals. Records are weighted for hospital characteristics as well as for patient diagnoses, age, and admission month, so that analyses can produce reliable national estimates. Because the NIS implemented a new systematic sampling design in 2012, revised sampling weights were used for all analyses. Crohn's disease was defined for a first-listed diagnosis field and for any of 15 diagnosis fields during 2003–2008 and 25 fields during 2009–2013 with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) disease codes 555.0–555.9. For states, the number of hos-pitalizations in 2013 with any diagnosis of Crohn's disease was obtained using the online query tool** from 35 states