Increase in Prevalence of Inflammatory Bowel Disease Among Insured Patients in Puerto Rico from 2018 to 2022

Background:
The prevalence of inflammatory bowel disease (IBD) is higher in Western Europe compared to other regions, and rates are increasing in racial and ethnic minorities and in countries with previous low prevalence. There are gaps in our understanding of IBD in Latin America and the Caribbean due to limited studies on trends and patterns of this disease. Therefore, we aim to estimate the overall prevalence of IBD in a commercially insured population in Puerto Rico from 2018 to 2022.
Methods:
This cross-sectional, retrospective study used de-identified insurance claims databases from commercial health insurers in PR. Cases identified had ICD-10 codes for IBD and fulfilled at least 1 of the following criteria: 2 hospitalizations for IBD, 4 IBD-related physician visits, 1 IBD drug pharmacy claim plus 1 of the former, or 2 ambulatory center IBD claims plus 1 of the former. Variables include age, gender, insurance type (Medicare Advantage or commercial insurance), IBD diagnosis, IBD-related physician visits, endoscopies, emergency room visits, hospitalizations and surgery. Period prevalence was defined as a new and pre-existing case during a 12-month period over the average number of insured population for the study period. Estimates are presented as the number of cases per 100,000 insured individuals with the corresponding 95% confidence intervals (CI) using Poisson regression. The study was approved by MSC-IRB.
Results:
The average insured population for the study period was 1,764,543. IBD was identified in 6,293 individuals of which 35.6% had Crohn’s disease (CD), 61% had ulcerative colitis (UC), and 3.4% were classified as undetermined IBD. The overall prevalence of IBD was 356.6 per 100,000; prevalence was 127.1 per 100,000 for CD, and 217.5 per 100,000 for UC. Commercial insurance had a higher prevalence than Medicare Advantage (210.0 per 100,000 vs 146.6 per 100,000, respectively). IBD was more prevalent among females (200.8 per 100,000) than males (155.8 per 100,000). A total of 209 patients were < 19 years representing 11.8 per 100,000 of the total prevalence. The age group with the highest prevalence were adults ≥ 60 years, 133.1 per 100,000.
Conclusions:
Our findings showed an increase in prevalence of IBD in Puerto Rico. Three previous studies have examined the prevalence of IBD on the island utilizing data from insurance claims. Estimates from 1996 placed the prevalence of commercially insured patients at 138.5 per 100,000, while a more rigorous study from 2005 revealed a prevalence within the same type of insured patients of 61.8 per 100,000. The last study used a database covering all commercial and government insurance claims for the year 2013, reporting an overall prevalence of 181.5 per 100,000 and a prevalence for commercially insured patients of 150.1 per 100,000. Our findings showed a significant increase in the overall prevalence of IBD in commercially insured population compared to previous estimates, supporting the recent rising global trends of this disease and underscoring the need for ongoing research and targeted healthcare strategies. Similar data for the Medicaid insured population of Puerto Rico is being studied and should provide a more complete vision of IBD in Puerto Rico.