Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study

Abstract

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery.

Incidence Trends of Inflammatory Bowel Disease in a Southern European Country: A Mirror of the Western World?

“…In our study, the North region presented the highest IBD incidence during the whole analyzed period (Figure 5 ). This tendency became more notorious with time and seemed to agree with that registered in Spain, where the cumulative incidence of IBD in 2017 was higher in the Central and North regions of the country ( 17 ). We anticipate that this predisposition might be related to the genetic heritage of the northern populations that partially results from movements entering the Iberian Peninsula from Northern and Central Europe in the Iron Age ( 19 ).…”

“…In addition, the average incidence between 2017 and 2019 (20 cases/1,000 person-year) can be considered high and is in line with the numbers registered in other European countries (17).…”

“…In addition, the average incidence between 2017 and 2019 (20 cases/1,000 person-year) can be considered high and is in line with the numbers registered in other European countries ( 17 ). High incidence values are pointed because of the Western lifestyle and have been linked to environmental factors associated with westernization ( 9 , 18 ).…”

Nationwide COVID-19-EII Study: Incidence, Environmental Risk Factors and Long-Term Follow-Up of Patients with Inflammatory Bowel Disease and COVID-19 of the ENEIDA Registry

“…These data are in the upper limit of the wide range of incidence previously described [10,14,28], ranging from 0.95 [29] to 100 per 1000 [15]. The universal access to health care within the National Health System in Spain (less than 3% of IBD patients with private insurance never use public services [30]) and the adherence of most centres to the nationwide certification programme in IBD [26] provide homogeneity to the cohort, minimizing potential bias in the clinical characteristics. We did not calculate the comparative incidence of COVID-19 between the IBD cohort and data obtained from the general population because the identification of cases did not use the same methodology.…”

Comprehensive Management of Inflammatory Bowel Disease: What’s Next

“…A substantial proportion of patients with CD and IBD in general require hospitalization or surgery during their lifetime. A large-scale nation-wide study conducted by Chaparro et al in Spain showed high cumulative incidences of IBD (16.2%), corresponding with reports in northern Europe [ 5 ]. This study demonstrated higher rates of medical therapies and surgical interventions as well as significantly higher hospitalization rates among patients with CD compared to patients with UC.…”