Stable colorectal cancer burden in inflammatory bowel disease over a decade: Nationwide U.S. trend analysis, 2012–2022.

Abstract

e15651 Background: Colorectal cancer (CRC) remains a significant long-term complication of inflammatory bowel disease (IBD). Most risk estimates derive from older, referral-based cohorts that predate modern biologic therapies and current endoscopic surveillance practices. We have yet to fully characterize the current population-level burden of CRC among hospitalized IBD patients in the era of advanced treatments. Methods: We conducted a retrospective cross-sectional analysis of adult IBD hospitalizations using the National Inpatient Sample (2012–2022). We identified CRC cases using a composite diagnostic definition. Using survey-weighted methods, we estimated annual CRC prevalence overall and by IBD subtype, including ulcerative colitis (UC) and Crohn’s disease (CD). Multivariable survey-weighted logistic regression models identified factors associated with CRC, including age, sex, race, payer, income quartile, hospital characteristics, comorbidities, and calendar year, to assess temporal trends formally. Results: CRC prevalence among hospitalized IBD patients was consistently low during the study period, ranging from 0.22% to 0.33% overall. When comparing IBD subtypes, the prevalence was higher among UC admissions (0.26%–0.55%) than among CD admissions (0.13%–0.26%). No consistent change in CRC prevalence over time was observed in either group. In multivariable analyses, increasing age emerged as the strongest and most consistent predictor of CRC. Patients aged 55–64 and 65 years or older had significantly higher odds of CRC compared to those aged 18–39. Compared with CD, UC was independently associated with higher CRC odds in several years. Other variables—such as sex, race, payer type, income quartile, and hospital characteristics—were not consistently associated with CRC. In terms of healthcare utilization, CRC was associated with more extended hospital stays (mean 7.9 vs 5.1 days) and higher total charges (mean $103,863 vs $60,620) compared with non-CRC IBD admissions. Conclusions: In a contemporary, nationally representative cohort of hospitalized IBD patients, CRC prevalence has remained low and stable over the past decade. These findings challenge historical perceptions of an increasing CRC burden in IBD and suggest that advances in surveillance and disease-modifying therapies may have reduced population-level risk. Age and disease phenotype primarily influence CRC risk in IBD, rather than temporal trends or healthcare access, which supports a transition toward individualized, risk-based surveillance strategies.