Epidemiology and the cost burden of hospitalized pediatric-onset inflammatory bowel disease in China: A national database study.

Importance: Understanding the epidemiology and cost burden of pediatric-onset inflammatory bowel disease (PIBD) is crucial for shedding light on its pathogenesis and making medical insurance decisions, particularly for very early-onset IBD (VEO-IBD).

Objective: To assess the epidemiology and cost burden of hospitalized PIBD and VEO-IBD.

Methods: A multicenter study identified hospitalized PIBD patients aged 0-18 years using the FUTang Updating medical REcords database from 28 hospitals in mainland China (2016-2021). Sociodemographic, clinical characteristics, length of stay (LOS), and expense data were analyzed. The cost burden was evaluated by dividing annual out-of-pocket expenditure by household disposable income. Clinical epidemiology and cost burden were compared between Crohn's disease (CD), ulcerative colitis (UC), IBD-unclassified (IBD-U), and different age groups.

Results: A total of 5230 hospitalized cases of PIBD were identified. Mean ages for CD (11.8 ± 3.9 years) and UC (8.0 ± 5.2 years) were significantly higher than those of patients with IBD-U (4.5 ± 4.1 years). Hospitalizations for CD showed a notable annual increase. Patients with CD had a shorter LOS (median 3 days) than those with UC (median 6 days) and IBD-U (median 7 days). The number of VEO-CD hospitalizations increased, while that of VEO-UC declined (2016-2021). The median total hospitalization expenses were $1006.7 for CD and $841.6 for UC. The average proportion of annual cost burden of IBD for each PIBD patient from 2016 to 2021 was 16.47%, 14.34%, 20.55%, 18.45%, 12.13%, and 11.16%, respectively, which has declined significantly since 2020.

Interpretation: This study provides insight into the clinical characteristics and cost burden of PIBD and VEO-IBD in China. Hospitalizations for PIBD, particularly for CD, are increasing. Guidelines and health insurance policies can help mitigate this cost burden.