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Epidemiology of inflammatory bowel disease: Is there a shift towards onset at a younger age?
Christian P Braegger1, Pierluigi Ballabeni, Daniela Rogler
1Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland. christian.braegger@kispi.uzh.ch
Insights
The incidence of pediatric Crohn disease (CD) and ulcerative colitis (UC) is not shifting to younger ages. Instead, the age of disease onset for these inflammatory bowel diseases (IBD) is increasing over time.
Area of Science:
- Gastroenterology
- Epidemiology
- Pediatric Inflammatory Bowel Disease
Background:
- Reports suggest increasing numbers of pediatric and adolescent patients with Crohn disease (CD) and ulcerative colitis (UC).
- A potential explanation is a shift towards earlier disease onset in these inflammatory bowel diseases (IBD).
Purpose of the Study:
- To investigate whether the observed increase in pediatric and adolescent IBD cases is due to earlier disease onset.
- To analyze trends in age at disease onset for CD and UC using retrospective data.
Main Methods:
- Retrospective analysis of patient data from the Swiss IBD Cohort Study (SIBDCS) diagnosed from 1980 onwards.
- Stratification by CD and UC diagnosis, analyzing age at disease onset (first symptoms and diagnosis) against calendar year of onset.
- Linear regression models adjusted for sex, country of birth, and education.
Main Results:
- A significant positive trend was observed for age at disease onset in both CD and UC, indicating onset at older ages over time.
- Male sex was associated with increased age at onset, while birth in Switzerland was linked to a decrease.
- These associations were statistically significant.
Conclusions:
- The findings do not support the hypothesis of earlier disease onset for CD and UC.
- There is a significant trend towards later age at disease onset for these conditions.
- The increase in pediatric and adolescent IBD cases is likely due to overall rising incidence, not a shift to younger ages.
Objectives:
Increasing numbers of paediatric and adolescent patients with Crohn disease (CD) and ulcerative colitis (UC) are reported. To determine whether this observation is a consequence of a shift towards onset at a younger age, we analysed retrospective data from patients enrolled in the Swiss IBD Cohort Study (SIBDCS).
Patients And Methods:
The SIBDCS is a disease-based cohort in Switzerland, which collects retrospective and prospective data on a large sample of patients with inflammatory bowel disease (IBD). Patients, diagnosed from 1980, were stratified according to diagnosis of CD and UC. Age at disease onset (age at first symptoms and age at diagnosis) was analysed in relation to calendar year of disease onset. Data were extracted from physician and patient questionnaires. Linear regressions of age at disease onset by calendar year of disease onset adjusted by sex, country of birth, and education were performed.
Results:
Adjusted regression coefficients for CD and UC were significantly positive, that is, age at disease onset has increased with time. Male sex was associated with an increase in age at disease onset, and birth in Switzerland with a decrease. These associations were statistically significant.
Conclusions:
The results from the SIBDCS do not support the hypothesis that disease onset of both CD and UC occur today at a younger age. On the contrary, our results show that there is a significant trend for age at disease onset occurring at an older age today as compared with recent decades. We conclude that the observation of increasing numbers of paediatric and adolescent patients with IBD is not caused by a trend towards disease onset at a younger age, but that this may rather be a consequence of the overall increasing incidence of these conditions.
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