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Incidence in pediatric IBD is rising: help from health administrative data.

T he authors aimed, first, to develop and validate a diagnostic algorithm for pediatric inflammatory bowel disease (IBD) using a health administrative database at the Institute for Clinical Evaluation Sciences in Toronto in order to identify subjects with early-onset IBD. This algorithm was then used to assess the incidence and the prevalence of IBD among children in the Ontario region. The database used included: 1) data from all hospital discharges that were reported to the Canadian Institute for Health; 2) billing claims for all physician services from Ontario Health Insurance Plan; and 3) Registered Persons Database (demographic data including region of residence). The authors used the IBD clinical database from SickKids in Toronto to identify patients with childhood-onset IBD in the area of Toronto. With this database the authors identified 183 Toronto children with an IBD diagnosis between 1991 and 1995 to serve as a positive reference standard. In the same time interval more than 930,000 children ages <15 years and who resided in Toronto served as a negative reference standard. From 1994 to 2005 there was a marked rise in the ageand sex-standardized prevalence of IBD per 100,000 population from 42.1 to 56.3, respectively (P < 0.0001). Prevalence of Crohn’s disease (CD) has increased from 23.9 to 31.6 (P < 0.0001) and that of ulcerative colitis (UC) from 16.2 to 19.7 (P < 0.0001). The Ontario Crohn’s and Colitis Cohort (OCCC), created using the validated algorithm, contains 3169 cases of pediatric IBD, diagnosed from 1994 to 2005. The IBD incidence rate has increased from 9.5 to 11.4 per 100,000 (P 1⁄4 0.03), with the incidence of CD changing from 5.0 to 6.0 per 100,000 (P 1⁄4 0.19). The incidence rate of UC has remained unchanged (from 4.1 to 4.2 per 100,000). Interestingly, if time trends in incidence stratified by age groups were considered, significant increases in incidence were seen in patients with IBD in the 6-month to 4year-old (50%/year, P 1⁄4 0.03) and 5–9-year-old (7.6%/year, P < 0.001) age groups. There was also a male predominance of CD patients in the younger age groups (5–9 years and 10–14 years), while in the age range of to 15–17 years there was a balance between sexes. UC was more likely in males at younger ages (<10 years), while it was more common in females during preadolescence and adolescence. In summary, a marked rise in the prevalence and incidence of pediatric IBD has been reported, mainly in children under the age of 10 years, using health administrative data from various sources. The authors suggest that other investigator groups apply the algorithm to administrative data from other jurisdictions after validating it as a common basis for future multicenter data exchange and collaborative research.