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
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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).
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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.