Original article
Alimentary tract
Prevalence of Eosinophilic Esophagitis in the United States

https://doi.org/10.1016/j.cgh.2013.09.008Get rights and content

Background & Aims

Eosinophilic esophagitis (EoE) has become a major cause of upper gastrointestinal morbidity in children and adults. However, there are few data on the nationwide prevalence of EoE. We aimed to estimate the prevalence of EoE in the United States.

Methods

We collected health insurance claims from a large database that represented the U.S. commercially insured population. We analyzed data from 2008 to 2011, identifying cases of EoE by using a previously validated definition, and calculated a period prevalence by using data from 2009 to 2011. EoE was defined as any instance of the International Classification of Diseases, 9th revision code 530.13. We calculated the prevalence of the code in the database and standardized the estimate to the U.S. population.

Results

Of 35,575,388 individuals in this database, 16,405 had at least 1 code for EoE. The mean age was 33.5 years, 65% were male, 55.8% had dysphagia, and 52.8% had a diagnostic code for at least 1 allergic condition. Among 11,569,217 individuals with continuous insurance coverage between mid-2009 and mid-2011, 6513 had at least 1 code for EoE. When standardized to the U.S. population, the estimated period prevalence of EoE was 56.7/100,000 persons, translating to approximately 152,152 cases in the U.S. Prevalence peaked in men 35-39 years old, with a rate of 114.6/100,000 persons.

Conclusions

Despite its relatively recent description, EoE is frequently diagnosed in the United States, with an estimated prevalence of 56.7/100,000 persons. This estimate depends on the accuracy of the International Classification of Diseases, 9th revision code, but it could be an underestimate, because knowledge of the code and recognition of EoE are increasing.

Section snippets

Study Design, Data Source, and Case Definition

We performed a retrospective analysis of the IMS LifeLink PharMetrics Health Plan Claims Database (IMS Health Inc, Waterton, MA). This database contains longitudinal, integrated, fully adjudicated medical and pharmaceutical claims for more than 75 million individuals from more than 80 health plans and has been shown to be representative of a U.S. national commercially insured population.17, 18 Enrollees' demographic data including age, sex, and census region (East, South, Midwest, and West)

Characteristics of Eosinophilic Esophagitis Cases

A total of 35,575,388 individuals in the database from 2008-2011 with continuous enrollment of at least 6 months represented the initial source population. Of these, 16,405 had at least 1 code for 530.13 and comprised the EoE case group. These patients were an average of 33.5 years old, and 64.9% were male (Table 1). The mean number of 530.13 ICD-9 claims per case was 7.4 (median, 4), and the number of identified cases substantially increased between 2008 and 2009, likely indicating increasing

Discussion

During the past decade, EoE has emerged as a major cause of upper gastrointestinal morbidity in both children and adults.3, 5, 6, 7, 10, 11, 14, 19, 24, 25 However, estimates of the prevalence of EoE in the United States have been limited by fragmented medical record systems and a lack of validated or consistently applied disease definitions. The aim of this study was to characterize cases of EoE and estimate the prevalence of EoE in the United States in a large database with methodology not

Acknowledgements

The statements, findings, conclusions, views and opinions contained and expressed in this article are based in part on data obtained under license from the following IMS Health Incorporated information service: LifeLink PharMetrics Health Plan Claims Database (January 1, 2001 through November 30, 2011), IMS Health Incorporated. All Rights Reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IMS Health Incorporated or

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    Conflicts of interest The authors disclose no conflicts.

    Funding Supported in part by a University of North Carolina Junior Faculty Development Grant (E.S.D.) and NIH Awards K23 DK090073 (E.S.D.) and K08 DK088957 (M.D.K.).

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