Epidemiology and Burden of Disease Associated with Short Bowel Syndrome in Korea

Abstract

Background/Objective: There is a lack of large database research relating to the epidemiology and burden of disease associated with short bowel syndrome (SBS) in South Korea. The aim of this study is to investigate the epidemiologic features of SBS and to assess the burden of SBS from the National Health Insurance Service–National Sample Cohort (NHIS-NSC) who had at least once SBS underlying disease in 2002-2013 for the first time in Korean population. Method: This study analyzed the NHIS-NSC database, consisting of 1,025,340 participants who was randomly selected, comprising 2.2% of the total eligible Korean population in 2002, and followed for 12 years until 2013 unless participants eligibility was disqualified due to death or emigration. Patients with SBS were operationally defined as three groups

definite/probable/possible SBS using combination of diagnostic code, operational code and hospitalization period. Prevalence and incidence estimation, co-morbidities analysis, survival analysis and cost estimation were conducted. Results: A total of 344 individuals were identified as patients with SBS (219 possible SBS, 119 probable SBS, 6 definite SBS) among 47,406 patients who had at least once SBS underlying disease during the period of 2002-2013. The prevalence of SBS was about 2-3 per hundreds of thousands and its incidence rate was 0.135 per person-year. Kaplan-Meier survival curves show that all SBS groups were associated with the highest risk in the congenital disease group. In terms of medical and economic burden of disease of SBS, data confirmed that SBS in Korea imposes a substantial medical and economic burden. When categorized according to health care institution, the proportion of total SBS patients in primary clinics was 6.1% and that in referral centers, defined as general hospitals plus hospitals, was 90.9% and that in convalescent hospitals was 3.0%. The mean (±standard deviation) length of stay in clinics for any of outpatients and admission was 6.1 ± 13.2 days per year and that in hospitals was 63.1 ± 139.6 days. The mean (±standard deviation) length of stay in general hospitals was 80.2 ± 85.8 days per year and that in convalescent hospitals was the longest, 200.0 ± 401.9 days per year which means patients who are in convalescent hospitals spend more than half of year in hospitals. Conclusion: The SBS is ultra-rare disease but give experience of complicated inpatient courses related to their disease as well as high economic burden of disease. This study represents the first use of national health claims data to study the epidemiology and burden of disease associated with SBS.