Nationwide prevalence and drug treatment practices of inflammatory bowel diseases in Hungary: A population-based study based on the National Health Insurance Fund database

doi:10.1016/j.dld.2016.07.012

Digestive and Liver Disease

Volume 48, Issue 11, November 2016, Pages 1302-1307

https://doi.org/10.1016/j.dld.2016.07.012 Get rights and content

Abstract

Background

Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases associated with a substantial healthcare utilization.

Aim

Our aim was to estimate the national prevalence of inflammatory bowel disease (IBD), CD and UC and to describe current drug treatment practices in CD and UC.

Methods

Patients and drug dispensing events were identified according to international classification codes for UC and CD in in-patient care, non-primary out-patient care and drug prescription databases (2011–2013) of the National Health Insurance Fund.

Results

A total of 55,039 individuals (men: 44.6%) with physician-diagnosed IBD were alive in Hungary in 2013, corresponding to a prevalence of 0.55% (95% CI, 0.55–0.56). The prevalence of CD 0.20% (95% CI, 0.19–0.20), and UC was 0.34% (95% CI, 0.33–0.34). The prevalence both in men and women was the highest in the 20–39 year-olds in CD. Current use of immunosuppressives and biological therapy was highest in the pediatric CD population (44% and 15%) followed by adult CD (33% and 9%), while their use was lowest in elderly patients. Interestingly, current use of 5-ASA (5-aminosalicylates) was high in both UC and CD irrespective of the age group.

Conclusions

The Hungarian IBD prevalence based on nationwide database of the National Health Insurance Fund was high. We identified significant differences in the drug prescription practices according to age-groups.

Introduction

Several studies aimed to better define the burden of inflammatory bowel disease (IBD) and a number of them established markedly increased IBD incidence over the past decades. The incidence and prevalence of IBD has been reported to vary geographically, with the highest prevalence in Canada and Europe [1]. Recent prevalence estimates in Europe ranged from 2.4 to 294 cases per 100,000 for ulcerative colitis (UC) and from 1.5 to 213 cases per 100,000 for Crohn's disease (CD) [2], [3], [4], [5].

Traditionally, the highest incidence and prevalence rates in Europe were found in Scandinavia and in the United Kingdom, while the prevalence remained low in Eastern and Southern Europe – suggesting a north-west and a south-east gradient in IBD incidence [5], [6]. The ECCO-EpiCom (European Crohn's and Colitis Organization–Epidemiological Committee) study with two inception cohorts of IBD patients diagnosed in 2010 and 2011 reported significantly higher IBD incidence rates in Western Europe compared to Eastern Europe [7], [8]. In the 2010 ECCO-EpiCom inception cohort, overall annual incidence rates in Western European centres were roughly twice as high as rates in Eastern European centres for CD (incidence rate ratio (IRR) = 1.9, 95% CI 1.5–2.4) and UC (IRR = 2.1, 95% CI 1.8–2.6), with the highest incidence on the Faroe Islands (81.5 per 100,000 per year). Interestingly, the IBD incidence reported from Hungary (23 per 100,000) was the highest among the Eastern European centres and equalled the rates found in the Nordic countries [7]. In addition, recent epidemiological studies from Croatia also reported increasing incidence and comparable prevalence rates to Western Europe [9], [10]. In contrast, other Central and Eastern European countries (e.g., Czech Republic, Poland, Romania, Slovakia, and Baltic countries) still reported low incidence and prevalence rates [11].

The comparison of IBD incidence and prevalence rates across multiple studies is complicated due to differences in data collection techniques, case definitions, study period and limited sample sizes. Although prospective, population-based studies are preferable in descriptive epidemiology, these are both expensive and time consuming and therefore limited nationwide data are available from prospective registries. The studies based on the public health registry systems afford nationwide data, nevertheless the validation of data source is complicated and the case definitions depend on the health care systems.

In Hungary, previous epidemiological studies were published from the population-based Veszprem Province database enrolling all IBD patients diagnosed in Veszprem province (in West-Hungary) from 1977 (the data collection is prospective from 1985). In the study by Lakatos et al. the prevalence rates in 2006 were 211.1 cases per 100,000 persons for UC, 115.3 cases per 100,000 persons for CD, and 11.8 cases per 100,000 persons in IBD-unclassified (IBD-U) in Veszprem province, which were relatively high, similar to those reported from the high-incidence areas in Western European countries [12]. Regarding the treatment strategy, systemic steroid, azathioprine (AZA) and biological therapy exposure was 68.6%, 45.8% and 9.5% in the Veszprem cohort (1977–2008), which was in line with rates found in the ECCO-EpiCom 2011 inception cohort [8], [13].

However, nationwide epidemiological data on the prevalence, the territorial distribution and the treatment strategy of IBD in Hungary are lacking.

The aim of the present study was to estimate the nationwide age and gender specific prevalence of IBD in Hungary and in the different regions of the country. Additionally, our secondary aim was to investigate the treatment strategy in different age groups both in CD and UC.

Section snippets

Data collection

Patients were identified through International Classification of Diseases (ICD-10) codes in the health administrative database of the National Health Insurance Fund (OEP), which is the only state-owned health care provider in Hungary. It provides universal health insurance for every residents including free-of-charge coverage for general practitioner, specialists’ care and in-hospital services. It is mandatory to report all in- and outpatient events including patients’ demographic data,

Nationwide IBD prevalence according to the different case definitions

A total of 55,039 IBD patients with at least yearly one IBD-related code in the in- or outpatient databases between 01.01.2011 and 31.12.2013 were identified equaling a prevalence rate of 0.55% (95% CI, 0.54–0.56). In total 19,911 CD patients (44.3% males, prevalence: 0.20% (95% CI, 0.19–0.20)), and 33,760 UC patients (44.7% males, prevalence: 0.34% (95% CI, 0.33–0.34)) had at least yearly one IBD-related health care visit reported. In total, there were slightly more females (30,475, 55.4%)

Discussion

This is the first study to estimate the nationwide, age-specific and regional prevalence of IBD in Hungary, based on data from the National Health Insurance Fund database. We found a high IBD prevalence, equaling 0.55% for IBD, 0.20% for CD and 0.34% for UC. The prevalence was lower (0.31% for IBD, 0.13% for CD and 0.18% for UC) if only actively treated IBD patients were considered. Prevalence rates were even higher than the previous estimates based on the Veszprem IBD cohort in 2006 (0.21% for

Conflict of interest

None declared.

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Alimentary TractNationwide prevalence and drug treatment practices of inflammatory bowel diseases in Hungary: A population-based study based on the National Health Insurance Fund database

Abstract

Background

Aim

Methods

Results

Conclusions

Introduction

Section snippets

Data collection

Nationwide IBD prevalence according to the different case definitions

Discussion

Conflict of interest

Journal of Crohn's and Colitis

Journal of Crohn's and Colitis

Best Practice and Research. Clinical Gastroenterology

Journal of Crohn's and Colitis

Journal of Crohn's and Colitis

Journal of Crohn's and Colitis

Digestive and Liver Disease

Journal of Clinical Epidemiology

Clinical Gastroenterology and Hepatology

Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review

Gastroenterology

Epidemiology of inflammatory bowel disease in adults who refer to gastroenterology care in Romania: a multicentre study

European Journal of Gastroenterology and Hepatology

Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003–2005: a population-based study from the Danish Crohn colitis database

American Journal of Gastroenterology

The incidence of Crohn's disease is not decreasing in Sweden

Scandinavian Journal of Gastroenterology

Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD)

Gut

East–west gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort

Gut

Incidence of inflammatory bowel disease in Primorsko-goranska County, Croatia, 2000–2004: a prospective population-based study

Scandinavian Journal of Gastroenterology

Incidence and prevalence of inflammatory bowel disease in Vukovarsko-Srijemska County, Croatia, 1991–2000 and 2001–2010: a population-based study

Collegium Antropologicum

Is the incidence and prevalence of inflammatory bowel diseases increasing in Eastern Europe?

Postgraduate Medical Journal

Alimentary Tract
Nationwide prevalence and drug treatment practices of inflammatory bowel diseases in Hungary: A population-based study based on the National Health Insurance Fund database