Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: A large population-based study

Abel B Quaresma; Aderson O M C Damiao; Claudio S R Coy; Daniela O Magro; Adriano A F Hino; Douglas A Valverde; Remo Panaccione; Stephanie B Coward; Siew C Ng; Gilaad G Kaplan; Paulo G Kotze

doi:10.1016/j.lana.2022.100298

Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: A large population-based study

Lancet Reg Health Am. 2022 Jun 9:13:100298. doi: 10.1016/j.lana.2022.100298. eCollection 2022 Sep.

Authors

Affiliations

¹ Universidade do Oeste de Santa Catarina, UNOESC, Colorectal Surgery, Joaçaba, Brazil.
² University of Sao Paulo, Gastroenterology, São Paulo, Brazil.
³ University of Campinas UNICAMP, Colorectal Surgery Unit, Campinas, Brazil.
⁴ Catholic University of Paraná, Health Sciences Postgraduate Program, Curitiba, Brazil.
⁵ Techtrials Healthcare, Data Science, Vinhedo, Brazil.
⁶ University of Calgary, Department of Medicine, Division of Gastroenterology and Hepatology, Calgary, Canada.
⁷ Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
⁸ Catholic University of Paraná, IBD outpatient Clinics, Colorectal Surgery Unit, Curitiba, Brazil.

Abstract

Background: Population-based data on epidemiology of Inflammatory Bowel Diseases (IBD) in Brazil are scarce. This study aims to define temporal trends of incidence and prevalence rates of Crohn's disease (CD) and ulcerative colitis (UC) in Brazil.

Methods: All IBD patients from the public healthcare national system were included from January 2012 to December 2020. Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using log-linear regression for incidence and binomial regression for prevalence. Moran's I autocorrelation index was used to analyse clustering of cities by level of prevalence.

Findings: A total of 212,026 IBD patients were included. Incidence of IBD rose from 9.4 in 2012 to 9.6 per 100,000 in 2020 (AAPC=0.8%; 95% CI -0.37, 1.99); for UC, incidence increased from 5.7 to 6.9 per 100,000 (AAPC=3.0%; 95% CI 1.51, 4.58) and for CD incidence decreased from 3.7 to 2.7 per 100,000 (AAPC=-3.2%; 95% CI -4.45, -2.02). Prevalence of IBD increased from 30.0 in 2012 to 100.1 per 100,000 in 2020 (AAPC=14.8%; CI 14.78-14.95); for UC, from 15.7 to 56.5 per 100,000 (AAPC=16.0%; CI 15.94, 16.17); for CD from 12.6 to 33.7 per 100,000 (AAPC=12.1% CI 11.95, 12.02). A south-north gradient was observed in 2020 prevalence rates of IBD [I=0.40 (p<0.0001)], CD [I=0.22 (p<0.0001)] and UC [I=0.42 (p<0.0001)].

Interpretation: Incidence of CD is decreasing whereas of UC is increasing, leading to stabilization in the incidence of IBD from 2012 to 2020 in Brazil. Prevalence of IBD has been climbing with 0.1% of Brazilians living with IBD in 2020.

Funding: None.

Keywords: AAPC, Average Annual Percent Change; AC, Acre; AL, Alagoas; AM, Amazonas; AP, Amapá; BA, Bahia; Brazil; CAAE, Certificate of Presentation for Ethical Appreciation; CD, Crohn's disease; CE, Ceará; CI, confidence intervals; Crohn's disease; DATASUS, Department of Health Informatics/Ministry of Health; DF, Distrito federal; ES, Espírito Santo; Epidemiology; GO, Goiás; IBD, Inflammatory Bowel Diseases; IBDU, Inflammatory Bowel Diseases undetermined; IBGE, National Institute of Geographics and Statistics (Instituto Brasileiro de Geografia e Estatística); ICD-10, Classification of Diseases and Related Health Problems, Tenth Revision; Incidence; Inflammatory bowel disease; MA, Maranhão; MG, Minas Gerais; MS, Mato Grosso do Sul; MT, Mato Grosso; PA, Pará; PB, Paraíba; PE, Pernambuco; PI, Piauí; PR, Paraná; Prevalence; RN, Rio Grande do Norte; RO, Rondônia; RR, Roraima; RS, Rio Grande do Sul; SC, Santa Catarina; SE, Sergipe; SP, São Paulo; SUS, national public health system (Sistema Único de Saúde); TO, Tocantins; UC, ulcerative colitis; UNOESC, University of the West of Santa Catarina; Ulcerative colitis.