Temporal hospitalization trends for inflammatory bowel disease in Taiwan

Background/Aims: Scant population-based data are available for inflammatory bowel disease (IBD)-related hospitalization rates in Asian countries. We investigated the epidemiological trends of hospitalization rate and lengths of hospital stay of the IBD population in Taiwan. Methods: Data for the period from 2001 to 2017 were retrieved from the National Health Insurance database. The average annual percentage change (AAPC) was analyzed by summarizing the trend with an underlying Joinpoint regression model. Data for the prebiologics era (2001-2010) and postbiologics era (2011-2017) were compared using regression discontinuity design. Results: A total of 4,376 patients with IBD were analyzed (1,167 Crohn's disease [CD] and 3,209 ulcerative colitis [UC]). Between 2001 and 2017, the all-cause hospitalization rates per 100,000 person-years increased significantly in those with IBD (AAPC, 10.5%; 95% confidence interval [CI], 9.6% to 11.4%), CD (AAPC, 14.1%; 95% CI, 10.0% to 18.5%), and UC (AAPC, 10.1%; 95% CI, 8.3% to 11.8%). However, hospitalization rates per 100 patients with IBD decreased for IBD (AAPC, -2.6%; 95% CI, -4.0% to -1.2%) and UC (AAPC, -1.8%; 95% CI, -2.8% to -0.7%) but not for CD (AAPC, -1.6%; 95% CI, -3.5% to 0.4%). Significant downward trends in length of hospital stay were identified for patients with IBD. Hospitalization, surgical, and mortality rates associated with IBD were significantly lower in the postbiologic than in the prebiologic eras. Conclusions: We observed an upward hospitalization trend relative to the general population but a downward trend within the IBD population in Taiwan. The declining hospitalization, surgical, and mortality rates might be attributed to advances in clinical management.