Understanding the scope of a problem is imperative in order to take action in healthcare. For Canadians who live with inflammatory bowel disease (IBD); for those who will; for the clinicians who treat them; and for researchers hunting for new clues, the latest Impact of IBD in Canada report published by Crohn’s and Colitis Canada describes the nationwide burden of IBD and what governments and healthcare institutions must brace for.
IBD affects 270,000 Canadians today and will affect 400,000 by 2030 – a full 1 percent of the population. The cost of caring for them, which currently sits at $2.6 billion a year, will grow in step with that trend. And there are gaps in that care: rural areas face a scarcity of gastroenterologists to expertly manage IBD. Crohn’s disease and ulcerative colitis impact Canadians at opposite ends of the age spectrum: while older adults are the fastest growing group of patients, children are the fastest growing group for new diagnoses.
This report not only explores the impact of IBD on Canadians and key scientific gaps in knowledge, but demands we hold vital conversations about the future. With IBD clinics already stressed by the volume of patients, how will they manage such a surge in demand? How can telemedicine or other new technologies and models of care provide more patients with access to specialists? How can we bring expensive biologic therapies, vastly superior to older drugs, to those who need them?
The number of Canadian children with IBD has climbed 50 percent in just 10 years. Dr. Eric Benchimol, pediatric gastroenterologist and epidemiologist at the Children’s Hospital of Eastern Ontario (CHEO) and University of Ottawa, says we are identifying it earlier thanks to newer technology; additionally, the medical community has greater recognition that this is a pediatric disease and doctors are more willing to order endoscopies and MRIs to identify Crohn’s and colitis in youngsters.
However, the reasons for this rising rate in children remain unknown.
“Everywhere in the Western world, rates of new diagnoses among adults are stable but rates among children are spiking,” says Dr. Benchimol, co-author of the Impact of IBD in Canada report. “This alarming trend is a call for us to investigate early-life environmental risk factors and other underlying causes of IBD.”
IBD early in life presents unique challenges, from inflammation causing stunted growth and early osteoporosis, to medication side effects, to the common related problems of anxiety and depression. Children must be closely monitored and require frequent visits to clinics and imaging departments.
“Our biggest challenge is getting kids fully back to a normal childhood – attending school, playing, being with friends, enjoying activities without being impeded by fatigue, pain, or other symptoms,” says Dr. Benchimol. “And we have a limited time period to optimize their care and heal their bowels, which often means we use fairly aggressive treatment. Children will live with this disease all their life, so we must start strong early.”
Meanwhile, the cohort of older adults is rising along with the demand for IBD treatment, fueled by Canadians diagnosed in their teens and twenties who have reached retirement age. In less than two decades, boomers will elevate Canada’s senior population to 9.5 million (23 percent of the country) from about 6 million seniors in 2016.
This unprecedented “silver wave” brings its own set of challenges, from meeting the demand for care to plotting how to treat Crohn’s and colitis when other health conditions are present. Medication interactions, increased risk of infection, higher rates of cancer – not to mention juggling the distinct needs of newly diagnosed seniors vs. long-term patients – are factors that create a minefield of uncertainty the medical and research community must wade through. While the ultimate impact on the Canadian healthcare system is yet unknown, we nonetheless must prepare.
“We face the significant challenge of contending with age-related comorbidities such as type 2 diabetes and cancer,” says Dr. Gilaad Kaplan, gastroenterologist and epidemiologist at the University of Calgary and co-author of the report. “Managing IBD is difficult on its own, but decisions are far more complex when balancing the medical management of other conditions.
“What’s more is that, every day in Canada, gastroenterologists are making a brand new diagnosis of IBD in an elderly patient.”
Though the rural population in Canada is declining, those who do live outside of city centres are aging at a much faster rate than their urban and suburban counterparts. Rural Canadians often have difficulty accessing specialized care simply because there are fewer practicing gastroenterologists, and travelling long distances to see them may be difficult or undesirable. Studies have shown that this leads to disparities in care.
Crohn’s and Colitis Canada’s Promoting Access and Care through Centres of Excellence (PACE) network is working to address this gap by establishing telehealth links with centres of excellence across the country. Instead of travelling or waiting months for an appointment, patients living in remote areas of the country can receive guidance and specialized treatment by healthcare professionals from afar.
“Embedding a specialist in one’s healthcare team can lead to vastly different outcomes, including reducing the need for surgery in favour of medical therapy, which is the more desirable treatment option,” says Dr. Benchimol.
The Impact of IBD in Canada report is a crucial instrument as we face the challenges to come posed by these diseases. To policymakers, it illustrates the science behind Crohn’s and colitis specific to Canada. To scientists, it shines light on any gaps in research that might exist.
“Ultimately,” says Dr. Benchimol, “this report asks: what are we going to have to do in the future to make a difference?”
Read more about other Crohn’s and Colitis Canada funded research
Read the Impact of IBD in Canada report.