M Ellen Kuenzig1,2, Alain Bitton3, Matthew W Carroll4, Gilaad G Kaplan5, Anthony R Otley6, Harminder Singh7,8,9, Geoffrey C Nguyen10,11,12, Anne M Griffiths1,13, Therese A Stukel10,12, Laura E Targownik11, Jennifer L Jones14, Sanjay K Murthy10,15,16,17,18, Jeffrey D McCurdy15,16,17, Charles N Bernstein7,8, Lisa M Lix19,20, Juan Nicolás Peña-Sánchez21, David R Mack22,23,24, Kevan Jacobson25, Wael El-Matary26, Trevor J B Dummer27, Stephen G Fung10,23,24, Sarah Spruin10, Zoann Nugent7, Divine Tanyingoh5, Yunsong Cui14, Christopher Filliter28, Stephanie Coward5, Shabnaz Siddiq10,23,24, Eric I Benchimol1,2,10,13,22,23,24. 1. SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada. 2. Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada. 3. McGill University Health Centre, Division of Gastroenterology and Hepatology, Montreal, Québec, Canada. 4. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. 5. Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 6. Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. 7. Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada. 8. Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. 9. Research Institute at CancerCare Manitoba, Winnipeg, Manitoba, Canada. 10. ICES, Toronto, Ontario, Canada. 11. Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 12. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 13. Department of Paediatrics, and Institute of Health Policy, Management and Evaluation University of Toronto, Toronto, Ontario, Canada. 14. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 15. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 16. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 17. Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada. 18. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. 19. Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 20. George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada. 21. Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. 22. Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada. 23. CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada. 24. CHEO Research Institute, Ottawa, Ontario, Canada. 25. Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada. 26. Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada. 27. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. 28. Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, Québec, Canada.
Abstract
BACKGROUND AND AIMS: Although venous thromboembolism [VTE] is a well-known complication of inflammatory bowel disease [IBD] in adults, limited data exist on the risk in children. We report the incidence of VTE among children with and without IBD. METHODS: We conducted a matched cohort study within a distributed network of population-based Canadian provincial health administrative databases. Children <16 years diagnosed with IBD were identified using validated algorithms from administrative data in Alberta, Manitoba, Nova Scotia, Ontario and Québec and compared to age- and sex-matched children without IBD. Hospitalizations for VTE within 5 years of IBD diagnosis were identified. Generalized linear mixed-effects models were used to pool province-specific incidence rates and incidence rate ratios [IRR] with 95% confidence intervals [CI]. Hazard ratios [HR] from Cox proportional hazards models were pooled with fixed-effects meta-analysis. RESULTS: The 5-year incidence of VTE among 3593 children with IBD was 31.2 [95% CI 23.7-41.0] per 10 000 person-years [PY] compared to 0.8 [95% CI 0.4-1.7] per 10 000 PY among 16 289 children without IBD [unadjusted IRR 38.84, 95% CI 16.59-90.83; adjusted HR 22.91, 95% CI 11.50-45.63]. VTE was less common in Crohn's disease than ulcerative colitis [unadjusted IRR 0.47, 95% CI 0.27-0.83; adjusted HR 0.52, 95% CI 0.29-0.94]. The findings were similar for deep vein thrombosis and pulmonary embolism when comparing children with and without IBD. CONCLUSIONS: The risk of VTE is much higher in children with IBD than controls without IBD. While the absolute risk is low, we found a higher incidence rate than previously described in the pediatric literature.Conference Presentation: An abstract based on the data included in this paper was presented at Canadian Digestive Diseases Week [Montréal, Canada] in March 2020.
BACKGROUND AND AIMS: Although venous thromboembolism [VTE] is a well-known complication of inflammatory bowel disease [IBD] in adults, limited data exist on the risk in children. We report the incidence of VTE among children with and without IBD. METHODS: We conducted a matched cohort study within a distributed network of population-based Canadian provincial health administrative databases. Children <16 years diagnosed with IBD were identified using validated algorithms from administrative data in Alberta, Manitoba, Nova Scotia, Ontario and Québec and compared to age- and sex-matched children without IBD. Hospitalizations for VTE within 5 years of IBD diagnosis were identified. Generalized linear mixed-effects models were used to pool province-specific incidence rates and incidence rate ratios [IRR] with 95% confidence intervals [CI]. Hazard ratios [HR] from Cox proportional hazards models were pooled with fixed-effects meta-analysis. RESULTS: The 5-year incidence of VTE among 3593 children with IBD was 31.2 [95% CI 23.7-41.0] per 10 000 person-years [PY] compared to 0.8 [95% CI 0.4-1.7] per 10 000 PY among 16 289 children without IBD [unadjusted IRR 38.84, 95% CI 16.59-90.83; adjusted HR 22.91, 95% CI 11.50-45.63]. VTE was less common in Crohn's disease than ulcerative colitis [unadjusted IRR 0.47, 95% CI 0.27-0.83; adjusted HR 0.52, 95% CI 0.29-0.94]. The findings were similar for deep vein thrombosis and pulmonary embolism when comparing children with and without IBD. CONCLUSIONS: The risk of VTE is much higher in children with IBD than controls without IBD. While the absolute risk is low, we found a higher incidence rate than previously described in the pediatric literature.Conference Presentation: An abstract based on the data included in this paper was presented at Canadian Digestive Diseases Week [Montréal, Canada] in March 2020.
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Authors: M Ellen Kuenzig; Eric I Benchimol; Charles N Bernstein; Alain Bitton; Matthew W Carroll; Anne M Griffiths; Gilaad G Kaplan; Geoffrey C Nguyen; Anthony R Otley; Therese A Stukel; Trevor J B Dummer; Wael El-Matary; Kevan Jacobson; Jennifer L Jones; Lisa M Lix; David R Mack; Sanjay K Murthy; Juan-Nicolás Peña-Sánchez; Laura E Targownik; Stephen G Fung; Sarah Spruin; Stephanie Coward; Yunsong Cui; Christopher Filliter; Zoann Nugent; Shabnaz Siddiq; Harminder Singh Journal: J Pediatr Gastroenterol Nutr Date: 2022-06-07 Impact factor: 3.288
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