Emergency department utilisation for inflammatory bowel disease in the United States from 2006 to 2014

S. Ballou, W. Hirsch, P. Singh, V. Rangan, J. Nee, J. Iturrino, T. Sommers, J. Zubiago, N. Sengupta, A. Bollom, M. Jones, A. C. Moss, S. N. Flier, A. S. Cheifetz, A. Lembo

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Abstract

Background: Despite advances in treatment, patients with inflammatory bowel disease (IBD) frequently require emergency department (ED) visits and hospitalisations. Aims: To analyse trends in ED visits and subsequent hospitalisations for IBD in the United States (US). Methods: Data were analysed from the Nationwide Emergency Department Sample (NEDS) years 2006-2014. The NEDS is the largest all-payer ED database in the US, weighted to represent 135 million visits/year. IBD was identified using ICD-9 codes for Crohn's disease (CD) or ulcerative colitis (UC). Surgeries were identified using procedure codes. Results: The frequency of IBD-ED visits increased 51.8%, from 90 846 visits in 2006 to 137 946 in 2014, which was statistically significant in linear regression. For comparison, all-case ED use between 2006 and 2014 increased 14.8%. In-patient hospitalisations from the ED decreased 12.1% for IBD (from 64.7% rate of hospitalisation from the ED in 2006 to 52.6% in 2014), with a UC:CD ratio of 1.2:1 in 2006 and 1.3:1 in 2014. Chi-square analysis revealed that this was a significant decrease. Surgery rates also showed a statistically significant decrease. The mean ED charge per patient rose 102.5% and the aggregate national cost of IBD-ED visits increased 207.5%. CD accounted for over twice as many visits as UC in both years. UC, age, male gender, highest income quartile, private insurance, Medicaid/Medicare, and tobacco use were associated with in-patient admissions. Conclusions: The number of ED visits due to IBD and associated charges have continued to rise, while the rates of in-patient hospitalisations referred from the ED and surgeries have decreased.

LanguageEnglish
Pages913-921
Number of pages9
JournalAlimentary Pharmacology and Therapeutics
Volume47
Issue number7
DOIs
Publication statusPublished - Apr 2018

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Inflammatory Bowel Diseases
Hospital Emergency Service
Hospitalization
Ulcerative Colitis
Crohn Disease
International Classification of Diseases
Patient Admission
Medicaid
Tobacco Use
Medicare
Insurance
Linear Models
Databases
Costs and Cost Analysis

Cite this

Ballou, S. ; Hirsch, W. ; Singh, P. ; Rangan, V. ; Nee, J. ; Iturrino, J. ; Sommers, T. ; Zubiago, J. ; Sengupta, N. ; Bollom, A. ; Jones, M. ; Moss, A. C. ; Flier, S. N. ; Cheifetz, A. S. ; Lembo, A. / Emergency department utilisation for inflammatory bowel disease in the United States from 2006 to 2014. In: Alimentary Pharmacology and Therapeutics. 2018 ; Vol. 47, No. 7. pp. 913-921.
@article{de97f476d4d34d17879d90462811b80d,
title = "Emergency department utilisation for inflammatory bowel disease in the United States from 2006 to 2014",
abstract = "Background: Despite advances in treatment, patients with inflammatory bowel disease (IBD) frequently require emergency department (ED) visits and hospitalisations. Aims: To analyse trends in ED visits and subsequent hospitalisations for IBD in the United States (US). Methods: Data were analysed from the Nationwide Emergency Department Sample (NEDS) years 2006-2014. The NEDS is the largest all-payer ED database in the US, weighted to represent 135 million visits/year. IBD was identified using ICD-9 codes for Crohn's disease (CD) or ulcerative colitis (UC). Surgeries were identified using procedure codes. Results: The frequency of IBD-ED visits increased 51.8{\%}, from 90 846 visits in 2006 to 137 946 in 2014, which was statistically significant in linear regression. For comparison, all-case ED use between 2006 and 2014 increased 14.8{\%}. In-patient hospitalisations from the ED decreased 12.1{\%} for IBD (from 64.7{\%} rate of hospitalisation from the ED in 2006 to 52.6{\%} in 2014), with a UC:CD ratio of 1.2:1 in 2006 and 1.3:1 in 2014. Chi-square analysis revealed that this was a significant decrease. Surgery rates also showed a statistically significant decrease. The mean ED charge per patient rose 102.5{\%} and the aggregate national cost of IBD-ED visits increased 207.5{\%}. CD accounted for over twice as many visits as UC in both years. UC, age, male gender, highest income quartile, private insurance, Medicaid/Medicare, and tobacco use were associated with in-patient admissions. Conclusions: The number of ED visits due to IBD and associated charges have continued to rise, while the rates of in-patient hospitalisations referred from the ED and surgeries have decreased.",
author = "S. Ballou and W. Hirsch and P. Singh and V. Rangan and J. Nee and J. Iturrino and T. Sommers and J. Zubiago and N. Sengupta and A. Bollom and M. Jones and Moss, {A. C.} and Flier, {S. N.} and Cheifetz, {A. S.} and A. Lembo",
year = "2018",
month = "4",
doi = "10.1111/apt.14551",
language = "English",
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Ballou, S, Hirsch, W, Singh, P, Rangan, V, Nee, J, Iturrino, J, Sommers, T, Zubiago, J, Sengupta, N, Bollom, A, Jones, M, Moss, AC, Flier, SN, Cheifetz, AS & Lembo, A 2018, 'Emergency department utilisation for inflammatory bowel disease in the United States from 2006 to 2014', Alimentary Pharmacology and Therapeutics, vol. 47, no. 7, pp. 913-921. https://doi.org/10.1111/apt.14551

Emergency department utilisation for inflammatory bowel disease in the United States from 2006 to 2014. / Ballou, S.; Hirsch, W.; Singh, P.; Rangan, V.; Nee, J.; Iturrino, J.; Sommers, T.; Zubiago, J.; Sengupta, N.; Bollom, A.; Jones, M.; Moss, A. C.; Flier, S. N.; Cheifetz, A. S.; Lembo, A.

In: Alimentary Pharmacology and Therapeutics, Vol. 47, No. 7, 04.2018, p. 913-921.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Emergency department utilisation for inflammatory bowel disease in the United States from 2006 to 2014

AU - Ballou, S.

AU - Hirsch, W.

AU - Singh, P.

AU - Rangan, V.

AU - Nee, J.

AU - Iturrino, J.

AU - Sommers, T.

AU - Zubiago, J.

AU - Sengupta, N.

AU - Bollom, A.

AU - Jones, M.

AU - Moss, A. C.

AU - Flier, S. N.

AU - Cheifetz, A. S.

AU - Lembo, A.

PY - 2018/4

Y1 - 2018/4

N2 - Background: Despite advances in treatment, patients with inflammatory bowel disease (IBD) frequently require emergency department (ED) visits and hospitalisations. Aims: To analyse trends in ED visits and subsequent hospitalisations for IBD in the United States (US). Methods: Data were analysed from the Nationwide Emergency Department Sample (NEDS) years 2006-2014. The NEDS is the largest all-payer ED database in the US, weighted to represent 135 million visits/year. IBD was identified using ICD-9 codes for Crohn's disease (CD) or ulcerative colitis (UC). Surgeries were identified using procedure codes. Results: The frequency of IBD-ED visits increased 51.8%, from 90 846 visits in 2006 to 137 946 in 2014, which was statistically significant in linear regression. For comparison, all-case ED use between 2006 and 2014 increased 14.8%. In-patient hospitalisations from the ED decreased 12.1% for IBD (from 64.7% rate of hospitalisation from the ED in 2006 to 52.6% in 2014), with a UC:CD ratio of 1.2:1 in 2006 and 1.3:1 in 2014. Chi-square analysis revealed that this was a significant decrease. Surgery rates also showed a statistically significant decrease. The mean ED charge per patient rose 102.5% and the aggregate national cost of IBD-ED visits increased 207.5%. CD accounted for over twice as many visits as UC in both years. UC, age, male gender, highest income quartile, private insurance, Medicaid/Medicare, and tobacco use were associated with in-patient admissions. Conclusions: The number of ED visits due to IBD and associated charges have continued to rise, while the rates of in-patient hospitalisations referred from the ED and surgeries have decreased.

AB - Background: Despite advances in treatment, patients with inflammatory bowel disease (IBD) frequently require emergency department (ED) visits and hospitalisations. Aims: To analyse trends in ED visits and subsequent hospitalisations for IBD in the United States (US). Methods: Data were analysed from the Nationwide Emergency Department Sample (NEDS) years 2006-2014. The NEDS is the largest all-payer ED database in the US, weighted to represent 135 million visits/year. IBD was identified using ICD-9 codes for Crohn's disease (CD) or ulcerative colitis (UC). Surgeries were identified using procedure codes. Results: The frequency of IBD-ED visits increased 51.8%, from 90 846 visits in 2006 to 137 946 in 2014, which was statistically significant in linear regression. For comparison, all-case ED use between 2006 and 2014 increased 14.8%. In-patient hospitalisations from the ED decreased 12.1% for IBD (from 64.7% rate of hospitalisation from the ED in 2006 to 52.6% in 2014), with a UC:CD ratio of 1.2:1 in 2006 and 1.3:1 in 2014. Chi-square analysis revealed that this was a significant decrease. Surgery rates also showed a statistically significant decrease. The mean ED charge per patient rose 102.5% and the aggregate national cost of IBD-ED visits increased 207.5%. CD accounted for over twice as many visits as UC in both years. UC, age, male gender, highest income quartile, private insurance, Medicaid/Medicare, and tobacco use were associated with in-patient admissions. Conclusions: The number of ED visits due to IBD and associated charges have continued to rise, while the rates of in-patient hospitalisations referred from the ED and surgeries have decreased.

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U2 - 10.1111/apt.14551

DO - 10.1111/apt.14551

M3 - Article

VL - 47

SP - 913

EP - 921

JO - Alimentary Pharmacology and Therapeutics

T2 - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 7

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