Epidemiology, validation, and clinical characteristics of inflammatory bowel disease: the ABIS birth cohort study

BMC Gastroenterol. 2023 Jun 8;23(1):199. doi: 10.1186/s12876-023-02840-1.

Abstract

Background: Birth cohort studies with linked register-based data on inflammatory bowel disease (IBD) provide opportunities to prospectively study early-life determinants of the disease. However, register-based data often lack information on clinical characteristics and rely on diagnostic algorithms. Within the All Babies in Southeast Sweden (ABIS) cohort, we examined the validity of a register-based definition of IBD, its incidence, and clinical and therapeutic characteristics at diagnosis.

Methods: We followed 16,223 children from birth (1997-1999) until the end of 2020 for the diagnosis of IBD as defined by a minimum of two diagnostic codes for IBD in the Swedish National Patient Register (NPR). We described the incidence and cumulative incidence of IBD. Through a medical record review of cases diagnosed by the end of 2017, we examined the positive predictive value (PPV) for IBD and described its clinical characteristics and treatment.

Results: By 2020, at an average age of 22.2 years, 113 participants (0.74%, 95% confidence interval [CI] = 0.61-0.89) had a register-based diagnosis of IBD, corresponding to an incidence of 31.3 per 100,000 person-years of follow-up; the incidence for Crohn's disease (CD) was 11.1 per 100,000 person-years and 15.8 for ulcerative colitis (UC). Of 77 participants with a register-based definition of IBD by the end of 2017, medical records were identified for 61 participants, of whom 57 had true IBD (PPV = 93%; 95%CI = 0.87-1.00). While oral 5-aminosalicylic acid treatment was equally common in newly diagnosed CD and UC patients, biologics were more often used for newly diagnosed CD. The median faecal calprotectin levels were 1206 mg/kg at diagnosis and 93 mg/kg at the last follow-up (P < 0.001).

Conclusions: In this population-based sample of Swedish children and young adults the cumulative IBD incidence was 0.74. The validity of register-based definition of IBD was high and supports using such data to identify IBD patients in cohort studies.

Keywords: All Babies in Southeast Sweden; Incidence; Inflammatory bowel disease; Swedish National Patient Register; Validation.

MeSH terms

  • Adult
  • Child
  • Cohort Studies
  • Colitis, Ulcerative* / diagnosis
  • Colitis, Ulcerative* / drug therapy
  • Colitis, Ulcerative* / epidemiology
  • Crohn Disease* / diagnosis
  • Crohn Disease* / drug therapy
  • Crohn Disease* / epidemiology
  • Humans
  • Incidence
  • Inflammatory Bowel Diseases* / diagnosis
  • Inflammatory Bowel Diseases* / epidemiology
  • Registries
  • Sweden / epidemiology
  • Young Adult