P1209 Temporal trends in surgery and hospitalization rates for crohn's disease in Brazil: A population-based study
Authors: Dos Reis Guerra J A , Magro D O , Coy C S R , Valverde D A , Oliveira E S , Quaresma A B , Kotze P G 
Published: January 2025

Background

Crohn's Disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, primarily affecting young adults and adolescents. Biological therapies have advanced CD management, reducing hospitalizations and surgeries.

Methods

This retrospective, population-based study analyzed CD patients treated by the Brazilian Unified Health System (SUS) from 2012 to 2022. Patients were categorized by pharmacological treatment (azathioprine [AZA], infliximab [IFX], adalimumab [ADA]) based on dispensing records. Prevalence data were extracted from the Brazilian Institute of Geography and Statistics. Hospitalizations, surgeries, and prevalence trends were analyzed using TT Disease Explorer® and quantified as annual and average annual percent changes (AAPC). Statistical analysis was conducted in R software.

Results

From 2012 to 2022, CD prevalence increased 288.07%, from 14.20 to 52.64 cases per 100,000 inhabitants. The proportion of patients treated with AZA decreased from 44.79% to 19.13%, while IFX remained stable and ADA slightly declined (figure 1). In absolute terms, IFX and ADA usage rose by 251.09% and 242.48%, respectively. Hospitalizations dropped by 59.29%, 6.19% to 2.52%, and surgical procedures by 55.08%, 1.09% to 0.49% (figure 2).

Conclusion

The results indicate that despite the increase in CD prevalence, therapeutic interventions, especially involving biological agents, have been effective in reducing hospitalizations and surgeries. However, the proportional stability in the use of IFX and ADA, despite the absolute increase, suggests challenges in access and implementation of these therapies across Brazil. Additionally, potential coding errors in hospital records may influence data accuracy, possibly underestimating the true burden of hospitalizations and surgeries. Improvements in health record quality are essential to provide more accurate data and promote more efficient public policies.Over 11 years, there was a significant increase in CD prevalence in Brazil, accompanied by a notable reduction in hospitalizations and surgical procedures. Biological therapies have played a crucial role in improving disease management, though the direct relationship between their use and clinical outcomes requires further investigation. Future studies should focus on reference centers to confirm these trends and assist in planning public policies that optimize CD treatment and improve access to effective therapies in Brazil.

References

Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60(5):571-607. doi:10.1136/gut.2010.2241542.

Quaresma AB, Kaplan GG, Kotze PG. The globalization of inflammatory bowel disease: the incidence and prevalence of inflammatory bowel disease in Brazil. Curr Opin Gastroenterol. 2019;35(4):259-264. doi:10.1097/MOG.00000000000005343.

Quaresma AB, Damiao AOMC, Coy CSR, et al. Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: A large population-based study. Lancet Reg Health Am. 2022;13:100298. Published 2022 Jun 9. doi:10.1016/j.lana.2022.1002984.

Palacio FGM, de Souza LMP, Moreira JPL, Luiz RR, de Souza HSP, Zaltman C. Hospitalization and surgery rates in patients with inflammatory bowel disease in Brazil: a time-trend analysis. BMC Gastroenterol. 2021;21(1):192. Published 2021 Apr 27. doi:10.1186/s12876-021-01781-x

Figure 1: Proportion of patients by therapy used in Brazil's Unified Health System from 2012 to 2022.

Figure 2: Proportion of surgeries and hospitalizations among Crohn's Disease cases in Brazil's public healthcare system from 2012 to 2022.