Hospitalizations and in-hospital mortality for inflammatory bowel disease in Brazil

Abstract

BACKGROUND

Inflammatory bowel disease (IBD) is associated with complications, frequent hospitalizations, surgery and death. The introduction of biologic drugs into the therapeutic arsenal in the last two decades, combined with an expansion of immunosuppressant therapy, has changed IBD management and may have altered the profile of hospitalizations and in-hospital mortality (IHM) due to IBD.

AIM

To describe hospitalizations from 2008 to 2018 and to analyze IHM from 1998 to 2017 for IBD in Brazil.

METHODS

This observational, retrospective, ecological study used secondary data on hospitalizations for IBD in Brazil for 2008-2018 to describe hospitalizations and for 1998-2017 to analyze IHM. Hospitalization data were obtained from the Hospital Information System of the Brazilian Unified Health System and population data from demographic censuses. The following variables were analyzed: Number of deaths and hospitalizations, length of hospital stay, financial costs of hospitalization, sex, age, ethnicity and type of hospital admission.

RESULTS

There was a reduction in the number of IBD hospitalizations, from 6975 admissions in 1998 to 4113 in 2017 (trend: y = -0.1682x + 342.8; R² = 0.8197; P < 0.0001). The hospitalization rate also decreased, from 3.60/100000 in 2000 to 2.17 in 2010. IHM rates varied during the 20-year period, between 2.06 in 2017 and 3.64 in 2007, and did not follow a linear trend (y = -0.0005049x + 2.617; R² = 0,00006; P = 0.9741). IHM rates also varied between regions, increasing in all but the southeast, which showed a decreasing trend (y = -0.1122x + 4.427; R² = 0,728; P < 0.0001). The Southeast region accounted for 44.29% of all hospitalizations. The Northeast region had the highest IHM rate (2.86 deaths/100 admissions), with an increasing trend (y = 0.1105x + 1.110; R² = 0.6265; P < 0.0001), but the lowest hospitalization rate (1.15). The Midwest and South regions had the highest hospitalization rates (3.27 and 3.17, respectively). A higher IHM rate was observed for nonelective admissions (2.88), which accounted for 81% of IBD hospitalizations. The total cost of IBD hospitalizations in 2017 exhibited an increase of 37.5% compared to 2008.

CONCLUSION

There has been a notable reduction in the number of hospitalizations for IBD in Brazil over 20 years. IHM rates varied and did not follow a linear trend.

Keywords: Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Hospitalization; Hospital mortality; Hospital information systems; Epidemiology

Core Tip: This study provides an epidemiological profile of IBD hospitalizations in Brazil from 2008 to 2018 and analyzes in-hospital mortality (IHM) between 1998 and 2017. There was a reduction from 6975 hospital admissions in 1998 to 4113 in 2017 (trend: y = -0.1682x + 342.8; R² = 0.8197; P < 0.0001). The hospitalization rate decreased from 3.60/100000 in 2000 to 2.17 in 2010. The total cost of hospitalizations in 2017 showed an increase of 37.5% compared to 2008. IHM rates varied during the 20-year period and did not follow a linear trend, decreasing in the Southeast region but increasing in the Northeast region.