{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T23:18:40Z","timestamp":1789600720111,"version":"build-2803163510"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Biological therapy has transformed the natural course of inflammatory bowel disease, but there are still controversies regarding its potential to reduce surgical rates for Crohn\u2019s disease (CD). This study, conducted with the support of the Brazilian National Healthcare System, aimed to analyze temporal trends in surgery and hospitalization rates among patients with CD and to correlate these data with the dispensing of azathioprine (AZA), infliximab (IFX), and adalimumab (ADA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methodology<\/jats:title>\n                  <jats:p>This retrospective observational study used data from the National Public Healthcare Department of Informatics through the TT Disease Explorer\u00ae platform from 2012 to 2022. Demographic data, medications used, and the prevalence of surgical procedures and hospitalizations associated with the International Classification of Diseases codes for CD were analyzed. Annual average percent changes (AAPCs) were calculated to assess temporal trends.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between 2012 and 2022, there was a significant increase of 288.07% in the diagnoses of CD, rising from 27\u2005551 to 106\u2005917 cases. Concurrently, there was an increase in the absolute number of patients treated with AZA, IFX, and ADA, with increasing rates of 65.79%, 251.09%, and 242.48%, respectively. However, the proportion of patients receiving AZA per CD patients decreased by 57.28%, from 44.79% to 19.13% (AAPC\u2005=\u2005\u22127.94%, 95% CI, \u22128.05 to \u22127.83; P\u2005&amp;lt;\u2005.001). The use of IFX remained relatively stable, with a slight change from 13.82% to 12.50% (AAPC\u2005=\u20050.01%, 95% CI, \u22120.20 to 0.22; P\u2005=\u2005.935), while the use of ADA decreased by 11.75%, from 11.65% to 10.28% (AAPC\u2005=\u2005\u22121.74%, 95% CI, \u22122.48 to \u22121.82; P\u2005&amp;lt;\u2005.001). The absolute number of hospitalizations related to CD increased by 57.71%. Despite the rise in the number of cases and the greater availability of biological treatments, the proportion of hospitalized patients decreased by 59.29%, from 6.19% to 2.52% (AAPC\u2005=\u2005\u22127.04%, 95% CI, \u22127.42 to \u22126.66; P\u2005&amp;lt;\u2005.001). Similarly, the proportion of surgical procedures relative to the total number of cases decreased by 55.08%, from 1.09% to 0.49% (AAPC\u2005=\u2005\u22125.73%, 95% CI, \u22126.68 to \u22124.77; P\u2005&amp;lt;\u2005.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Despite the cumulative increase in the prevalence of CD cases in the country and the absolute increase in the dispensing of biologics, the proportion of hospitalizations and surgical procedures among CD patients treated in the public health system in Brazil decreased.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/crocol\/otae082","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T18:37:26Z","timestamp":1736447846000},"source":"Crossref","is-referenced-by-count":3,"title":["Temporal Trends in Surgery and Hospitalization Rates for Crohn\u2019s Disease in Brazil: A Population-Based Study"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3194-4517","authenticated-orcid":false,"given":"Jo\u00e3o Augusto","family":"dos Reis Guerra","sequence":"first","affiliation":[{"name":"Colorectal Surgery Unit, Catholic University of Paran\u00e1, IBD Outpatient Clinics , Curitiba ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8180-6254","authenticated-orcid":false,"given":"Daniela Oliveira","family":"Magro","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Unit, University of Campinas UNICAMP , Campinas ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0916-4138","authenticated-orcid":false,"given":"Claudio Saddy","family":"Rodrigues Coy","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Unit, University of Campinas UNICAMP , Campinas ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5413-5486","authenticated-orcid":false,"given":"Douglas A","family":"Valverde","sequence":"additional","affiliation":[{"name":"Techtrials Healthcare, Data Science , Vinhedo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6296-0969","authenticated-orcid":false,"given":"Emilia Sousa","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Campinas UNICAMP , Campinas ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3985-7402","authenticated-orcid":false,"given":"Abel Botelho","family":"Quaresma","sequence":"additional","affiliation":[{"name":"Health Sciences Postgraduate Program, Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1 (PUCPR) , Curitiba ,","place":["Brazil"]},{"name":"IBD Outpatient Clinic, Colorectal Surgery Unit, Universidade do Oeste de Santa Catarina, UNOESC ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2053-5315","authenticated-orcid":false,"given":"Paulo Gustavo","family":"Kotze","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Unit, Catholic University of Paran\u00e1, IBD Outpatient Clinics , Curitiba ,","place":["Brazil"]},{"name":"Health Sciences Postgraduate Program, Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1 (PUCPR) , Curitiba ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"issue":"9573","key":"2025040911024949300_CIT0001","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.1016\/S0140-6736(07)60750-8","article-title":"Inflammatory bowel disease: cause and immunobiology","volume":"369","author":"Baumgart","year":"2007","journal-title":"Lancet."},{"issue":"1","key":"2025040911024949300_CIT0002","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1053\/j.gastro.2011.10.001","article-title":"Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review","volume":"142","author":"Molodecky","year":"2012","journal-title":"Gastroenterology."},{"issue":"5","key":"2025040911024949300_CIT0003","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1136\/gut.2010.224154","article-title":"Guidelines for the management of inflammatory bowel disease in adults","volume":"60","author":"Mowat","year":"2011","journal-title":"Gut."},{"issue":"10","key":"2025040911024949300_CIT0004","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1016\/j.cgh.2020.10.039","article-title":"Contemporary risk of surgery in patients with ulcerative colitis and Crohn\u2019s disease: a meta-analysis of population-based cohorts","volume":"19","author":"Tsai","year":"2021","journal-title":"Clin Gastroenterol Hepatol."},{"issue":"6","key":"2025040911024949300_CIT0005","doi-asserted-by":"publisher","first-page":"685","DOI":"10.5009\/gnl19209","article-title":"Biologics for the management of inflammatory bowel disease: a review in tuberculosis-endemic countries","volume":"14","author":"Banerjee","year":"2020","journal-title":"Gut Liver"},{"issue":"12","key":"2025040911024949300_CIT0006","doi-asserted-by":"publisher","first-page":"1840","DOI":"10.1038\/ajg.2017.394","article-title":"Surgical rates for Crohn\u2019s disease are decreasing: a population-based time trend analysis and validation study","volume":"112","author":"Ma","year":"2017","journal-title":"Am J Gastroenterol."},{"issue":"2","key":"2025040911024949300_CIT0007","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1053\/j.gastro.2021.10.037","article-title":"Efficacy of biologic drugs in short-duration versus long-duration inflammatory bowel disease: a systematic review and an individual-patient data meta-analysis of randomized controlled trials","volume":"162","author":"Ben-Horin","year":"2022","journal-title":"Gastroenterology."},{"issue":"1","key":"2025040911024949300_CIT0008","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1038\/s41575-020-00360-x","article-title":"The four epidemiological stages in the global evolution of inflammatory bowel disease","volume":"18","author":"Kaplan","year":"2021","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"10114","key":"2025040911024949300_CIT0009","doi-asserted-by":"publisher","first-page":"2769","DOI":"10.1016\/S0140-6736(17)32448-0","article-title":"Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies","volume":"390","author":"Ng","year":"2017","journal-title":"Lancet."},{"issue":"9","key":"2025040911024949300_CIT0010","doi-asserted-by":"publisher","first-page":"2211","DOI":"10.1016\/j.cgh.2022.06.030","article-title":"Global hospitalization trends for Crohn\u2019s disease and ulcerative colitis in the 21st century: a systematic review with temporal analyses","volume":"21","author":"Buie","year":"2023","journal-title":"Clin Gastroenterol Hepatol."},{"issue":"4","key":"2025040911024949300_CIT0011","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1097\/MOG.0000000000000534","article-title":"The globalization of inflammatory bowel disease: the incidence and prevalence of inflammatory bowel disease in Brazil","volume":"35","author":"Quaresma","year":"2019","journal-title":"Curr Opin Gastroenterol."},{"key":"2025040911024949300_CIT0012","doi-asserted-by":"publisher","first-page":"100298","DOI":"10.1016\/j.lana.2022.100298","article-title":"Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: a large population-based study","volume":"13","author":"Quaresma","year":"2022","journal-title":"Lancet Reg Health. Am"},{"key":"2025040911024949300_CIT0013","doi-asserted-by":"publisher","first-page":"423","DOI":"10.2147\/CEG.S176583","article-title":"Inflammatory bowel disease epidemiology in S\u00e3o Paulo State, Brazil","volume":"11","author":"Gasparini","year":"2018","journal-title":"Clin Exp Gastroenterol."},{"issue":"1","key":"2025040911024949300_CIT0014","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s12876-018-0822-y","article-title":"The prevalence and phenotype in Brazilian patients with inflammatory bowel disease","volume":"18","author":"Lima Martins","year":"2018","journal-title":"BMC Gastroenterol."},{"key":"2025040911024949300_CIT0015","author":"DATASUS","year":"2022"},{"key":"2025040911024949300_CIT0016","author":"IGBE","year":"2022"},{"key":"2025040911024949300_CIT0017","author":"SIGTAP","year":"2017"},{"key":"2025040911024949300_CIT0018","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-3846147\/v1","article-title":"The global evolution of inflammatory bowel disease across four epidemiologic stages","volume-title":"Res Sq","author":"Kaplan","year":"2024"},{"key":"2025040911024949300_CIT0019","year":"2024"},{"issue":"3","key":"2025040911024949300_CIT0020","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1590\/S0004-2803.201900000-59","article-title":"Biological therapy penetration for inflammatory bowel disease in Latin America: current status and future challenges","volume":"56","author":"Quaresma","year":"2019","journal-title":"Arq Gastroenterol."},{"issue":"3","key":"2025040911024949300_CIT0021","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/S2468-1253(23)00284-4","article-title":"Challenges in the diagnosis and treatment of inflammatory bowel disease in Latin America","volume":"9","author":"Balderramo","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"1","key":"2025040911024949300_CIT0022","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1186\/s12876-021-01781-x","article-title":"Hospitalization and surgery rates in patients with inflammatory bowel disease in Brazil: a time-trend analysis","volume":"21","author":"Palacio","year":"2021","journal-title":"BMC Gastroenterol."},{"key":"2025040911024949300_CIT0023","doi-asserted-by":"publisher","first-page":"1756284820931738","DOI":"10.1177\/1756284820931738","article-title":"Biologics and surgical outcomes in Crohn\u2019s disease: is there a direct relationship","volume":"13","author":"Quaresma","year":"2020","journal-title":"Therap Adv Gastroenterol"},{"issue":"Supplement_1","key":"2025040911024949300_CIT0024","doi-asserted-by":"publisher","first-page":"S576","DOI":"10.1093\/ecco-jcc\/jjab076.764","article-title":"P644 Hospitalization and abdominal surgery rates in CD according to drug-dispensing: a temporal trend analysis from the Brazilian public healthcare national system","volume":"15","author":"Magro","year":"2021","journal-title":"J Crohns Colitis."},{"issue":"5","key":"2025040911024949300_CIT0025","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1002\/ibd.21118","article-title":"Small bowel resection rates in Crohn\u2019s disease and the indication for surgery over time: experience from a large tertiary care center","volume":"16","author":"Lazarev","year":"2010","journal-title":"Inflamm Bowel Dis."},{"issue":"11","key":"2025040911024949300_CIT0026","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1136\/gutjnl-2013-306711","article-title":"Use of azathioprine in IBD: modern aspects of an old drug","volume":"63","author":"Louis","year":"2014","journal-title":"Gut."},{"issue":"5","key":"2025040911024949300_CIT0027","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/S2468-1253(24)00034-7","article-title":"A biomarker-stratified comparison of top-down versus accelerated step-up treatment strategies for patients with newly diagnosed Crohn\u2019s disease (PROFILE): a multicentre, open-label randomised controlled trial","volume":"21","author":"Noor","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"6","key":"2025040911024949300_CIT0028","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1159\/000493492","article-title":"Impact of modern drug therapy on surgery: ulcerative colitis","volume":"34","author":"Kuehn","year":"2018","journal-title":"Visc Med"}],"container-title":["Crohn's &amp; Colitis 360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/crohnscolitis360\/advance-article-pdf\/doi\/10.1093\/crocol\/otae082\/61398046\/otae082.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/crohnscolitis360\/article-pdf\/7\/1\/otae082\/61398046\/otae082.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/crohnscolitis360\/article-pdf\/7\/1\/otae082\/61398046\/otae082.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T11:04:12Z","timestamp":1744196652000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/crohnscolitis360\/article\/doi\/10.1093\/crocol\/otae082\/7950766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,30]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,12,30]]}},"URL":"https:\/\/doi.org\/10.1093\/crocol\/otae082","relation":{},"ISSN":["2631-827X"],"issn-type":[{"value":"2631-827X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1]]},"published":{"date-parts":[[2024,12,30]]},"article-number":"otae082"}}