title: Increasing hospitalizations in inflammatory bowel disease among children in the United States, 1988-2011.
abstract: BACKGROUND
  Our objective was to characterize national trends in inflammatory bowel disease (IBD)-related hospitalizations for children. We hypothesized that over time, improvements in care would be associated with a decrease in hospitalization rates, similar to what has been observed in Canadian children with IBD.
  
  
  METHODS
  Retrospective, serial, cross-sectional analysis of annual, nationally representative samples of children with IBD.
  
  
  RESULTS
  Overall, discharges for all children irrespective of diagnosis decreased from 1988 to 2011 (P for trend <0.001). In contrast, discharges for children with IBD rose over the same time period from 6.1 (95% confidence interval [CI], 4.0-8.2) to 8.2 (95% CI, 5.5-10.9) per 100,000 individuals per year (P for trend <0.001). More of this rise occurred in hospitalizations that did not have IBD-related endoscopy or surgery performed (P for trend <0.001). Although mean length of stay decreased over the study period (P for trend <0.001), total hospital days increased over the latter half of the study with a significant increase over the entire study period (P for trend <0.001).
  
  
  CONCLUSIONS
  Contrary to clinically informed hypotheses, nationally representative rates of hospitalization for pediatric patients with IBD have increased since the mid-1990s. This directly contrasts with stable rates over the preceding years. Most of the expansion in hospital care seems to be related to hospitalizations that do not include procedures. Several lines of future research may greatly facilitate a better understanding of the epidemiologic, therapeutic, and health care resource issues at play.
authors.affiliation: *Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan; †Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan; Divisions of ‡General Pediatrics, and §General Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan; ‖Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; and ¶Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Sandberg
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Gebremariam
authors.forename: Jeremy
authors.initials: J
authors.lastname: Adler
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007223:Infant; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology