Trends of Hodgkin and Non-Hodgkin's Lymphoma in Inflammatory Bowel Disease in the Biologic Era - A National Inpatient Sample (NIS) Study

Introduction: The association between inflammatory bowel disease (IBD) and risk of developing Hodgkin (HL) or non-Hodgkin lymphoma (NHL) is established in scientific literature. It is unclear if this risk is inherited in IBD or related to using immunomodulatory therapy in IBD. Here, we represent a study based on the National Inpatient Sample (NIS) database, the largest all-payer inpatient database in the USA, to analyse the trends of HL and NHL in IBD hospitalizations over time and examine the role of age, sex, and race on this association. Methods: We analysed the NIS data of adult hospitalizations for all IBD hospitalizations with lymphoma either as a primary or secondary discharge code from 2003-2017 using the validated ICD-9/10 codes. Age, sex and racial demographic factors were collected. Trend analysis of HL and NHL was performed with Cochran-Armitage and Jonckheere-Terpstra tests. Results: Overall Trends: From 2003 to 2017, a total of 734 (0.03%) and 8093 (0.36%) out of 2,235,413 ulcerative colitis (UC) hospitalizations and 1325 (0.1%) and 10803 (0.8%) out of 1,324,746 Crohn’s disease (CD) hospitalizations were related to HL and NHL respectively. Between 2003-2017, there has been a 25% and 32.56 % increase (PTrend < 0.007) in the rate of HL and NHL related admissions in UC group, and a 25% and 63.33% increase (PTrend < 0.02) in the rate of HL and NHL related admissions in CD group. Age: In NHL group, in both UC and CD cohorts, the age group > 65 had higher proportional prevalence than other age groups (P < 0.005), but similar finding was not seen in HL group, in both UC and CD cohorts. Sex: In NHL group, there was an increasing trend of female prevalence from 37.78% to 44.78% and 38.69% to 50.27% in UC and CD cohorts respectively (PTrend < 0.007). Similar trend was not seen in the HL group in both UC and CD. Ethnicity: In both UC and CD cohorts, HL and NHL related admissions appeared to be predominant in white patients, outweighing other races by at least 4 times. Conclusion: Our study demonstrates an increasing trend of HL and NHL related hospitalizations in IBD patients from 2003-2017. In both UC and CD cohorts, there appears to be an increasingly female predominance of NHL, but not HL. HL and NHL related admissions in both UC and CD was predominantly in white patients. While an increased use of immunomodulatory therapy may partly explain some of these findings, future studies are needed to validate these findings.Table 1.: Total number, trends, female and race proportion of hospitalized lymphoma in IBD population footnote: Number represent trend between 2003, and 2017, except female trend in Crohn’s with Hodgkins is between 2004 and 2017Figure 1.: Trends in annual prevalence of Hodgkin and non-Hodgkin lymphoma in Inflammatory bowel disease footnote: A: Trends in annual prevalence of Hodgkin lymphoma in Inflammatory bowel disease B: Trends in annual prevalence of non-Hodgkin lymphoma in Inflammatory bowel disease HL, Hodgkin lymphoma; NHL, non-Hodgkin lymphoma; UC, Ulcerative Colitis; CD, Crohn’s disease