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Letter
Is the incidence of paediatric inflammatory bowel disease still increasing?
  1. James John Ashton1,2,
  2. Mick Cullen1,
  3. Nadeem A Afzal1,
  4. Tracy Coelho1,
  5. Akshay Batra1,
  6. R Mark Beattie1
  1. 1 Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
  2. 2 Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
  1. Correspondence to Dr R Mark Beattie, Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton SO16 6YD, UK ; mark.beattie{at}uhs.nhs.uk

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There has been an increase in the incidence of paediatric inflammatory bowel disease (PIBD) over the last 20 years.1 2 We have previously published data from Wessex, England, reporting an incidence of 9.37/100 000/year (2008–2012), which significantly increased from 5.2/100 000/year in 1998–1999, 6.39/100 000/year in 2002–2006, and 7.82/100 000/year in 2003–2008.1 2 We now report the most recent disease incidence figures for Wessex, England (1 January 2013 to 31 December 2017) and analyse them with previously published Wessex data (1 January 2002 to 21 December 2012) demonstrating the most contemporary incidence and the trend over 16 years. The ‘Wessex’ population was estimated from the Office for National Statistics using defined postcodes, based on the contemporary referral area.1 3 Statistical analyses of the data were conducted using Pearson’s Χ2 test, Mann-Whitney U test and by simple linear regression (SPSS V.24, IBM).

From 2002 to 2017, there was a significant positive trend in PIBD incidence (R2=0.464, p=0.004) (figure 1) rising from 2013 to 2017 from 7.71/100 000/year to 10.54/100 000/year (R2=0.554, p=0.149); average incidence over the 5 years was 8.80/100 000/year. The median age at diagnosis was 13.48 years (IQR 11.08–15.14 years).

Figure 1

Incidence of paediatric inflammatory bowel disease (PIBD) in Wessex over a 16-year period (2002–2017). (Data taken from Ashton et al 1). All PIBD (R2=0.464, p=0.004), Crohn’s disease (CD; R2=0.314, p=0.024), ulcerative colitis (UC; R2=0.490, p=0.003), IBD-unclassified (IBDU; R2=0.103, p=0.224).

In the 2013–2017 cohort, the incidence of PIBD was higher in men compared with women, 10.84/100 000/year and 6.69/100 000/year, respectively (p=0.0001), driven by patients aged between 11 and 16 years at diagnosis (figure 2) with the incidence being comparable between genders at other ages. The overall 5-year incidence (2013–2017) of Crohn’s disease (CD) was 5.25/100 000/year compared with 3.31/100 000/year for ulcerative colitis (UC) (p=0.0002).

Figure 2

Incidence of paediatric inflammatory bowel disease by gender and age of onset from 2013 to 2017: (A) 0–5 years, (B) 6–10 years, (C) 11–16 years. CD, Crohn’s disease; IBD, inflammatory bowel disease; IBDU, IBD-unclassified; UC, ulcerative colitis.

From 2002 to 2017, there was a statistically significant positive trend in both CD incidence (R2=0.314, p=0.024) and UC incidence (R2=0.490, p=0.003), but was not seen in IBD-unclassified (R2=0.103, p=0.224) probably reflecting the low numbers.

The 2017 Wessex data (10.37/100 000/year) are in line with the highest reported global incidence of PIBD, supporting data detailing increased incidence in the UK over the last 30 years.4 Increased incidence in the paediatric population will result in an increase in the prevalence of PIBD, placing an increased requirement on current services. Median age of diagnosis in our data was 13.48 years with patients remaining in paediatric services for an estimated median time of 4 years (13.5–17.5 years) prior to transition to adult care. In our regional catchment population, the number of cases per year has increased from 50 (2013) to 68 (2017), a 36% increase. This has resulted in a significant impact on PIBD prevalence—50 cases staying in service for 4 years results in 200 patients with PIBD in paediatric care compared with 68 cases diagnosed per year resulting in 272 patients with PIBD in paediatric care. This has a significant potential impact on paediatric IBD service provision and contributes further to the increasing global burden of IBD.

References

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Footnotes

  • Contributors JJA and RMB conceived the study. JJA and MC collected the data. JJA analysed the data with help from all the authors. JJA and RMB wrote the manuscript with help from all the authors.

  • Funding JJA is funded by an Action Medical Research, Research Training Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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