Published online Jan 5, 2022. doi: 10.4292/wjgpt.v13.i1.1
Peer-review started: June 8, 2021
First decision: July 31, 2021
Revised: August 28, 2021
Accepted: January 5, 2022
Article in press: January 5, 2022
Published online: January 5, 2022
Processing time: 215 Days and 11.2 Hours
Inflammatory bowel disease (IBD) is associated with complications, frequent hospitalizations, surgery and death. The major causes of hospitalizations are disease activity, diagnostic procedures and surgery. 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.
In Brazil, there is still no integrated database of patients with IBD, limiting the development of comprehensive epidemiological studies. On the other hand, the Brazilian Unified Health System (SUS) has a hospital admission data collection system that allows partial analysis of the impact of IBD in the country.
We aim to describe the profile of hospitalizations and in-hospital deaths due to IBD in Brazil over 10 years and to analyze IHM over 20 years.
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 SUS and population data from demographic censuses. The temporal trend in hospitalizations and IHM was evaluated using simple linear regression.
There was a reduction in the number of IBD hospitalizations, from 6,975 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 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). 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.
There has been a notable reduction in the number of hospitalizations for IBD in Brazil over 20 years. Because we used secondary data, such information is prone to errors. To carry out a more comprehensive and reliable study, it is necessary to create a national IBD database.
For the future perspective, the creation of a national IBD database will allow more comprehensive and reliable studies.