Investigators Identify COVID-19 Trends for IBD Patients

Gilaad G. Kaplan, MD, MPH

The COVID-19 case rate changed throughout the pandemic based on geographic region for patients with inflammatory bowel disease (IBD).

A team, led by Gilaad G. Kaplan, MD, MPH, Departments of Medicine and Community Health Sciences, University of Calgary, explored the temporal trends in reporting of COVID-19 in patients with IBD throughout the different waves of the pandemic.

Since the beginning of the pandemic, patients with IBD were of a particular concern for increased risk of infection and complication because of disease activity and drug-induced immunocompromised status.

SECURE-IBD

The investigators used data from the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD), an international registry of patients with IBD who were diagnosed with COVID-19.

In SECURE-IBD, physicians enter anonymized COVID-19 cases for patients with either Crohn’s disease or ulcerative colitis into a secure database.

The team calculated the average percent changes in the weekly reported cases of COVID-19 during different waves—March 22-September 12 2020, September 13-December 12 2020, and December 13-July 31, 2021.

Overall, there were 6404 cases of COVID-19 across 73 countries included in the analysis.

Cases Based on Region

However, cases decreased globally by 4.2% per week (95% CI, -5.3% to -3.0%) during the first wave. This then increased by 10.2% per week (95% CI, 9.1-12.3%) during the second wave and then declined again by 6.3% per week (95% CI, -7.8% to -4.7%).

There were also trends found based on location.

For example, cases rose more in North America in the fall of 2020 (APC, 11.3%; 95% CI, 8.8-13.8%) and Europe (APC, 17.7%; 95% CI, 12.1-23.5%).

However, reporting was stable in Asia (APC, -8.1%; 95% CI, -15.6% to 0.1%).

During the final wave, cases for patients with IBD declined in North America (APC, −8.5%; 95% CI, −10.2% to −6.7%) and Europe (APC, −5.4%; 95% CI, −7.2% to −3.6%), but was stable in Latin America (APC, −1.5%; 95% CI, −3.5% to 0.6%).

Cases in the US

The investigators also stratified the results within the US to show geographic heterogeneity during the first 2 waves of the pandemic.

Here they found the Midwest was stable (APC, −0.4%; 95% CI, −2.3% to 1.6%) before September 13-19, but cases rose leading up to December 6-12 (APC, 17.0%; 95% CI, 10.8-23.6%).

On the other hand, cases in the Northeast decreased (APC, −10.0%; 95% CI, −12.3% to −7.6%) and then increased (APC, 19.2%; 95% CI, 11.5-27.5%).

The South increased (APC, 5.5%; 95% CI, 2.6-8.5%) and then stabilized (APC, −0.8; 95% CI, −6.8% to 5.5%), while cases of COVID-19 was stable in the West for patients with IBD during both the first (APC, −0.4%; 95% CI, −3.5% to 2.8%) and second (APC, 9.5%; 95% CI, −0.9% to 20.9%) periods.

But after December 13-19, cases in the US declined steadily by 9.2% per week (95% CI, -11.2% to -7.12%). This decline was found in all 4 regions of the US.

“After one year of reporting COVID-19 in those with IBD into the SECURE-IBD registry, our temporal trend findings are consistent with the epidemiological patterns COVID-19 globally,” the authors wrote. “The highest incidence of COVID-19 in IBD occurs in the Western world where the prevalence of IBD predominates.”

The study, “The Multiple Waves of COVID-19 in Patients With Inflammatory Bowel Disease: A Temporal Trend Analysis,” was published online in Inflammatory Bowel Diseases.