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Gastroenterology and hepatology
Original research
Incidence and prevalence of inflammatory bowel disease in UK primary care: a population-based cohort study
  1. Thomas Joshua Pasvol1,
  2. Laura Horsfall1,
  3. Stuart Bloom2,
  4. Anthony Walter Segal3,
  5. Caroline Sabin4,5,
  6. Nigel Field4,6,
  7. Greta Rait1,5
  1. 1The Research Department of Primary Care and Population Health, University College London, London, UK
  2. 2Medicine, University College London Hospitals NHS Foundation Trust, London, UK
  3. 3Medicine, University College London, London, UK
  4. 4Institute for Global Health, University College London, London, UK
  5. 5Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, NIHR, London, UK
  6. 6Centre for Molecular Epidemiology and Translational Research, University College London, London, UK
  1. Correspondence to Dr Thomas Joshua Pasvol; thomas.pasvol{at}nhs.net

Abstract

Objectives We describe temporal trends in the recorded incidence of inflammatory bowel disease (IBD) in UK primary care patients between 2000 and 2018.

Design A cohort study.

Setting The IQVIA Medical Research data (IMRD) primary care database.

Participants All individuals registered with general practices contributing to IMRD during the period 01 January 2000–31 December 2018.

Main outcome measures The primary outcome was the recorded diagnosis of IBD.

Results 11 325 025 individuals were included and 65 700 IBD cases were identified, of which 22 560 were incident diagnoses made during the study period. Overall, there were 8077 incident cases of Crohn’s disease (CD) and 12 369 incident cases of ulcerative colitis (UC). Crude incidence estimates of ‘IBD overall’, CD and UC were 28.6 (28.2 to 28.9), 10.2 (10.0 to 10.5) and 15.7 (15.4 to 15.9)/100 000 person years, respectively. No change in IBD incidence was observed for adults aged 17–40 years and children aged 0–9 years. However, for adults aged over 40 years, incidence fell from 37.8 (34.5 to 41.4) to 23.6 (21.3 to 26.0)/100 000 person years (average decrease 2.3% (1.9 to 2.7)/year (p<0.0001)). In adolescents aged 10–16 years, incidence rose from 13.1 (8.4 to 19.5) to 25.4 (19.5 to 32.4)/100 000 person years (average increase 3.0% (1.7 to 4.3)/year (p<0.0001)). Point prevalence estimates on 31 December 2018 for IBD overall, CD and UC were 725, 276 and 397 per 100 000 people, respectively.

Conclusions This is one of the largest studies ever undertaken to investigate trends in IBD epidemiology. Although we observed stable or falling incidence of IBD in adults, our results are consistent with some of the highest reported global incidence and prevalence rates for IBD, with a 94% rise in incidence in adolescents. Further investigation is required to understand the aetiological drivers.

  • inflammatory bowel disease
  • epidemiology
  • gastroenterology
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/bmjopen-2019-036584

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    Footnotes

    • Twitter @TPasvol

    • Contributors TJP: study concept and design; analysis and interpretation of data; drafting of the manuscript; statistical analysis; obtained funding. LH: study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; statistical analysis. SB and NF: study concept and design; critical revision of the manuscript for important intellectual content. AWS: study concept and design; critical revision of the manuscript for important intellectual content; obtained funding. CS: study concept and design; critical revision of the manuscript for important intellectual content; statistical analysis. GR: study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; study supervision. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This work was supported by The Charles Wolfson Charitable Trust (grant number 539234) and The Harbour Foundation (grant number 549321). Laura Horsfall is supported by a Wellcome Trust Fellowship (grant number 209207/Z/17/Z).

    • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

    • Competing interests TJP and AWS report research grants from The Charles Wolfson Charitable Trust and The Harbour Foundation for the submitted work.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval IMRD data collection was approved by the NHS South-East Multicentre Research Ethics Committee in 2003. This study was approved by the Scientific Research Committee (SRC) on 29/09/2018 (SRC reference 18THIN082).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Due to licence agreements with IQVIA, we are unable to share patient level data from the IQVIA Medical Research Database. However, we are happy to share our data extractions upon reasonable request. Data requesters should email the corresponding author to request the relevant data.

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