ORIGINAL ARTICLE
Update on the Incidence and Prevalence of Crohns Disease
and Ulcerative Colitis in Olmsted County, Minnesota,
1940 2000
Conor G. Loftus, MD, Edward V. Loftus, Jr., MD, W. Scott Harmsen, MS, Alan R. Zinsmeister, PhD,
William J. Tremaine, MD, L. Joseph Melton, III, MD, and William J. Sandborn, MD
Background: We previously reported that the prevalence of
Crohns disease (CD) and ulcerative colitis (UC) in Olmsted
County, Minnesota, had risen signicantly between 1940 and 1993.
We sought to update the incidence and prevalence of these condi-
tions in our region through 2000.
Methods: The Rochester Epidemiology Project allows popula-
tion-based studies of disease in county residents. CD and UC were
dened by previously used criteria. County residents newly diag-
nosed between 1990 and 2000 were identied as incidence cases,
and persons with these conditions alive and residing in the county on
January 1, 2001, were identied as prevalence cases. All rates were
adjusted to 2000 US Census gures for whites.
Results: In 1990 2000 the adjusted annual incidence rates for UC
and CD were 8.8 cases per 100,000 (95% condence interval [CI],
7.210.5) and 7.9 per 100,000 (95% CI, 6.39.5), respectively, not
signicantly different from rates observed in 1970 1979. On Janu-
ary 1, 2001, there were 220 residents with CD, for an adjusted
prevalence of 174 per 100,000 (95% CI, 151197), and 269 resi-
dents with UC, for an adjusted prevalence of 214 per 100,000 (95%
CI, 188 240).
Conclusion: Although incidence rates of CD and UC increased
after 1940, they have remained stable over the past 30 years. Since
1991 the prevalence of UC decreased by 7%, and the prevalence of
CD increased about 31%. Extrapolating these gures to US Census
data, there were 1.1 million people with inammatory bowel
Received for publication September 11, 2006; accepted September 18,
2006.
From the Inammatory Bowel Disease Clinic, *Division of Gastroenter-
ology and Hepatology, and Divisions of Biostatics and Epidemiology,
Mayo Clinic College of Medicine, Rochester, Minnesota.
Presented in part at the 104th Annual Meeting of the American Gastro-
enterological Association, Orlando, Florida, May 17-22, 2003 (Gastroenter-
ology 2003;124(4 Suppl 1):A36.)
Supported in part by the Mayo Foundation for Medical Education and
Research and grant AR30582 from the National Institutes of Health.
Reprints: Edward V. Loftus, Jr., MD, Division of Gastroenterology and
Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (e-mail:
loftus.edward@mayo.edu).
Copyright 2006 Crohns & Colitis Foundation of America, Inc.
DOI 10.1002/ibd.20029
Published online 19 December 2006 in Wiley InterScience (www.
interscience.wiley.com).
254
disease in the US in 2000.
(Inamm Bowel Dis 2007;13:254 261)
Key Words: Crohns disease, ulcerative colitis, incidence, preva-
lence, epidemiology
A lthough investigators have made signicant strides to-
ward a better understanding of the pathophysiology of
inammatory bowel disease (IBD) in recent years, this group
of conditions remains idiopathic.1 Genetic, environmental,
and immunological mechanisms of etiopathogenesis continue
to be explored.1 In addition, epidemiological studies are often
performed in patients with chronic conditions such as
Crohns disease (CD) and ulcerative colitis (UC) to provide
important information about the natural history, health care
burden, and causal mechanisms of the disease. In particular,
many centers have described increasing incidence rates of
CD217 and UC16 35 over the past 5 decades. More recently,
however, the incidence of CD36 and UC37 appears to be
stabilizing. Despite this, CD and UC continue to grow more
prevalent as a result of the early age of onset and low
mortality (albeit substantial morbidity) of these condi-
tions.2,3,6,7,1214,16,18,20,23,26,3539 It has been estimated that
there may be as many as 1.3 million persons in the US and
Canada with IBD.40
In contrast to studies performed on patients seen at
referral centers, population-based epidemiological studies are
more likely to reect the true spectrum of illness.41 In the US
the nonunied structure of health care delivery systems
makes such studies difcult. It is particularly difcult to
identify all cases of a given disease in a dened geographic
area, especially if such patients do not routinely require
hospitalization for the disease or its complications. In Olm-
sted County, Minnesota, however, the small number of insti-
tutions providing health care share a linked diagnostic index,
allowing for identication of all recognized cases of a par-
ticular disease, thus providing a suitable framework in which
population-based studies on IBD can be performed.36,37
A cohort of Olmsted County residents diagnosed with
IBD between 1935 and 1993 has been studied at several time
points.3,6,18,36 38 Between the 1950s and 1970s, the incidence
Inamm Bowel Dis Volume 13, Number 3, March 2007
Inamm Bowel Dis Volume 13, Number 3, March 2007
of CD in Olmsted County increased rapidly,3 but stabilized
thereafter at 7 cases per 100,000 person-years.36 The prev-
alence of CD in Olmsted County rose from 91 cases per
100,000 persons in 19836 to 144 cases per 100,000 persons in
1991.36 Likewise, the incidence of UC also increased rapidly
in the postwar period,18 peaking in the early 1970s, with a
stabilization in incidence thereafter.37 The prevalence of UC
in Rochester, Minnesota (the urban center of Olmsted
County) increased from 117 cases per 100,000 in 196518 to
268 cases per 100,000 in 1991.37 Olmsted County investiga-
tors have also reported that the incidence rate of CD was
greater in women6 and in the urban part of the county,3,6
while a male predominance of incident cases has been noted
in patients with UC.18,37,38 Whether the rise in incidence of
CD and UC represented a worsening environmental risk
prole or improved diagnostic techniques and case ascertain-
ment remains unclear.
Continued study of the epidemiology of CD and UC
may shed light on the etiopathogenesis of these conditions. In
addition, an updated population-based inception cohort of
IBD patients may serve as a platform for further detailed
epidemiologic studies and also provide valuable information
with regard to disease burden in a dened population. In the
current study the Olmsted County inception cohort of patients
with CD and UC was updated through 2000; previously
identied cases were reviewed to assure consistent diagnostic
criteria; and the prevalence of CD and UC was calculated on
January 1, 2001. Temporal trends in the incidence of CD and
UC were examined for the entire period, 1940 2000.
PATIENTS AND METHODS
Setting
Olmsted County is located in southeastern Minnesota
and had a population of 124,000 residents in the 2000 US
Census. Rochester is the urban center of Olmsted County,
comprised of 86,000 residents in 2000. The remainder of
the county is predominantly rural. In 2000, 90% of the
population of Olmsted County was white and 4% of the
population was African American. Although 25% of Olmsted
County residents are employed in health care services (8%
nationwide), and the level of education is somewhat higher,
with 30% having completed college (21% nationwide), resi-
dents of the county are otherwise similar to the US white
population from the socioeconomic standpoint.41
Rochester Epidemiology Project
The Rochester Epidemiology Project is a unique med-
ical records-linkage system that encompasses the care deliv-
ered to residents of Rochester and Olmsted County, Minne-
sota.41 This records-linkage system exploits the fact that
virtually all health care for the local residents is provided
either by Mayo Medical Center, comprised of the Mayo
Update on CD and UC in Olmsted County, MN
Clinic and its two afliated hospitals, or Olmsted Medical
Center, comprised of a smaller subspecialty group and its
afliated hospital. Each year, over half of the Olmsted
County population is examined at one of the Mayo facilities,
and during any given 3-year period greater than 90% of local
residents are examined at either one of the two health care
systems.41 The central diagnostic index of the Rochester
Epidemiology Project comprises all diagnoses generated
from outpatient evaluations, hospitalizations, emergency
room evaluations, nursing home visits, surgical procedures,
autopsy reports, and death certicates. It is therefore possible
to identify all cases of a disease for which patients sought
medical attention over a particular period of time.41 Through
the resources of this medical records linkage system, we
identied all permanent residents of Olmsted County who
were diagnosed with CD or UC between January 1, 1990, and
December 31, 2000.
Case Ascertainment
This study was approved by the Institutional Review
Boards of Mayo Clinic and Olmsted Medical Center. All
potential new cases of CD and UC were identied through the
central diagnostic index. A diagnosis of CD was conrmed if
at least two of the following criteria were satised, on two
occasions, separated by at least 2 months: 1) clinical history
of abdominal pain, diarrhea, weight loss, malaise, and/or
rectal bleeding; 2) endoscopic ndings of linear ulceration,
mucosal cobblestoning, skip areas, or perianal disease; 3)
radiologic ndings of stula, stricture, mucosal cobbleston-
ing, or ulceration; 4) laparotomy appearance of creeping
fat, bowel wall induration, and mesenteric lymphadenopa-
thy; or 5) histologic ndings of transmural inammation
and/or epithelioid granulomas. These criteria were identical
to those used in two previous studies of CD in Olmsted
County.6,36 A diagnosis of UC was made if a potential case
satised the following criteria, on two occasions, separated
by at least 6 months: 1) diffusely granular or friable colonic
mucosa on endoscopy; and 2) continuous mucosal involve-
ment as observed by endoscopy or barium studies. These
criteria were identical to those used in two previous studies of
UC in Olmsted County.37,38
The medical records of all Olmsted County residents in
previous studies of CD3,6,36 or UC18,37,38 (1940 1993) were
reexamined to conrm accurate diagnoses. The date of onset
of symptoms, date of diagnosis, residency on January 1,
2001, date of last follow-up, and vital status at last follow-up
were recorded.
Incidence and Prevalence Calculations
Annual incidence rates for UC and, separately, CD,
were estimated by dividing the number of events by the
population at risk, with direct standardization to the age and
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Loftus et al Inamm Bowel Dis Volume 13, Number 3, March 2007

TABLE 1. Age- and Sex-specic and Adjusted Incidence of Ulcerative Colitis in Olmsted County, Minnesota, 1940-2000, by
Decade
Age Group,
Years 1940-49 1950-59 1960-69 1970-79 1980-89 1990-2000

Females 0-19 0.0 1.0 1.3 2.5 1.3 1.1

20-39 5.1 9.3 14.4 14.9 10.2 13.3
40-49 4.0 5.1 4.3 11.0 7.1 8.4
60 3.8 2.8 8.0 6.3 5.2 3.9
Subtotal, age-adjusted 3.2 (0.7,5.7) 4.7 (2.1,7.4) 7.0 (4.2,9.8) 9.0 (6.0,11.9) 6.1 (3.98.3) 7.0 (5.0,9.0)
Males 0-19 0.0 1.9 4.7 1.8 4.4 5.2
20-39 1.6 5.6 17.2 21.4 17.5 12.9
40-59 6.4 5.6 12.4 14.1 13.5 14.1
60 4.3 0.0 13.9 4.8 12.0 10.9
Subtotal, age-adjusted 3.0 (0.3,5.7) 3.6 (1.2,6.0) 12.0 (7.9,16.1) 11.2 (7.7,14.7) 11.9 (8.6,15.3) 10.8 (8.1,13.6)
Total, age- and sex-
adjusted 3.1 (1.3,4.9) 4.2 (2.4,6.0) 9.4 (7.0,11.9) 10.1 (7.8,12.4) 8.9 (7.0,10.9) 8.8 (7.2,10.5)
Rates are expressed as cases per 100,000 person-years. Values in parentheses are 95% CI.

sex distribution of the 2000 US white population. The pop- RESULTS

ulation at risk was estimated by linear interpolation of decen-
nial census data for Olmsted County assuming the entire
population of the county to be at risk.42 The 95% condence
intervals (95% CI) were estimated assuming a Poisson dis-
tribution for the number of age, sex, and calendar year-
specic cases. A Poisson regression analysis was used to
assess the association of age, gender, and calendar year with
the crude incidence rates. Prevalence rates as of January 1,
2001, were estimated in the same manner as for incidence
rates.
Demographics
For the entire period, 1940 2000, 308 Olmsted
County residents were diagnosed with CD and 372 with
UC. One hundred fty-seven CD patients were female
(51%), while 211 of those diagnosed with UC were male
(57%). The diagnosis of both CD and UC was most com-
mon in the third and fourth decades of life. The median age
at diagnosis of CD was 29 years (range, 4 91), and the
median age at diagnosis of UC was 33 years (range, 1 88).
The median age at diagnosis of Crohns appeared to de-

TABLE 2. Age- and Sex-specic and Adjusted Incidence of Crohns Disease in Olmsted County, Minnesota, 1940-2000, by Decade
Age Group,
Years 1940-49 1950-59 1960-69 1970-79 1980-89 1990-2000

Females 0-19 0.0 1.0 1.3 5.6 6.5 3.3

20-39 3.8 3.5 12.6 18.3 10.2 10.8
40-49 0.0 3.4 7.1 6.1 2.0 8.4
60 0.0 5.5 4.0 4.7 2.6 5.9
Subtotal, age-adjusted 1.0 (0.0,2.2) 3.2 (0.9,5.4) 6.5 (3.8,9.3) 9.1 (6.3,11.9) 5.6 (3.6,7.5) 7.2 (5.2,9.3)
Males 0-19 0.0 0.0 2.0 4.3 4.4 6.2
20-39 0.0 2.8 16.1 11.9 15.0 11.3
40-59 10.7 1.9 1.6 6.4 6.2 6.0
60 4.3 3.4 5.6 2.4 6.0 12.3
Subtotal, age-adjusted 3.8 (0.7,6.8) 1.9 (0.0,3.9) 6.4 (3.6,9.3) 6.6 (4.0,9.2) 8.1 (5.5,10.8) 8.7 (6.3,11.2)
Total age- and sex-
adjusted 2.3 (0.8,3.9) 2.6 (1.1,4.1) 6.5 (4.5,8.5) 7.9 (6.0,9.8) 6.8 (5.2,8.4) 7.9 (6.3,9.5)
Rates are expressed as cases per 100,000 person-years. Values in parentheses are 95% CI.

256
Inamm Bowel Dis Volume 13, Number 3, March 2007 Update on CD and UC in Olmsted County, MN

TABLE 3. Age-specic Incidence of Ulcerative Colitis, Olmsted

County, 1940-2000, by Gender
Age Group, Years Males Females Total

0-19 3.4 1.3 2.4

20-29 16.2 12.1 13.9
30-39 12.4 11.5 12.0
40-49 11.4 7.1 9.2
50-59 13.1 7.2 10.1
60-69 10.0 5.5 7.6
70 7.0 4.7 5.6
FIGURE 1. Temporal trends in age-adjusted incidence of ulcer- Rates are expressed as cases per 100,000 person-years.
ative colitis in Olmsted County, Minnesota, 1940 2000, by gen-
der.

crease until 1970 1979 (26 years) and then increased
slightly (median, 34 years) in 1990 2000. In UC, the
median age decreased until 1970 1979 (31 years) and
increased as well (median, 35 years) in 1990 2000.
Among the CD patients, 89 had small bowel involvement
(29%), 91 had colonic involvement (30%), and 128 had
both small bowel and colonic involvement (41%). Among
the UC patients, 63 had proctitis (17%), 134 had left-sided
colitis (36%), and 174 had extensive colitis (47%).
Incidence
The overall age- and sex-adjusted incidence rates of CD
(Table 1) and UC (Table 2) in Olmsted County between 1940
and 2000 were 6.3 and 8.1 cases per 100,000 person-years,
respectively.
Crohns Disease
Over the entire study period, 1940 2000, there was a
signicant increase in the incidence of CD (P 0.0001)
(Figure 3), although the association of incidence rates with
time period depended on age group. Similarly, the association
of age group with incidence depended on the decade of CD
diagnosis (P 0.03 for the interaction effect in the Poisson
model). The 20 39 year age group typically had the highest
rates (exceptions were males in the decades of 1940 1949
and 1990 2000), from a low of 0.0 per 100,000 person-years
among males in the decade of 1940 1949 to a high of 18.3
among females in the decade of 1970 1979 (Table 2). There
was no signicant overall association of CD incidence with
gender (P 0.59) (Table 4, Figure 4). The age-adjusted rate
for males was 6.7 per 100,000 person-years (95% CI, 5.6
7.8) compared with 6.1 per 100,000 (95% CI, 5.17.1) for
females.

Ulcerative Colitis Prevalence

There was a signicant increase in the incidence of UC On January 1, 2001, there were 220 Olmsted County
over the entire study period (P 0.0001) (Figure 1). The residents alive with a diagnosis of CD and 269 residents with
rates in the rst 2 decades, 3.1 and 4.2 cases per 100,000
person-years, were signicantly lower than the annual inci-
dence in 1990 2000 (8.8 per 100,000). The incidence rates in
decades from the 1960s forward were relatively stable (Table
1, Figure 1). The overall age-adjusted annual incidence
among males (9.8 per 100,000; 95% CI, 8.4 11.2), was
signicantly higher than among females (6.5 per 100,000;
95% CI, 5.57.6) (Table 3, Figure 2). Incidence rates among
males and females were similar for the rst 2 decades, but the
rates for males were consistently higher from the 1960s
forward. A signicant association with age was also observed
(P 0.0001), as the highest incidence rate (13.9 per 100,000
person-years) was seen in the 20 39-year-old group, and the
lowest incidence was observed among those individuals 0 19
years of age (2.4 per 100,000 person-years) (Table 3). No FIGURE 2. Age-specic incidence of ulcerative colitis in Olm-
signicant interactions among gender, age group, and decade sted County, Minnesota, 1940 2000, by gender. Incidence is
of diagnosis were detected. expressed as cases per 100,000 person-years.

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Loftus et al Inamm Bowel Dis Volume 13, Number 3, March 2007

FIGURE 3. Temporal trends in age-adjusted incidence of FIGURE 4. Age-specic incidence of Crohns disease in Olm-
Crohns disease in Olmsted County, Minnesota, 1940 2000, by sted County, Minnesota, 1940 2000, by gender. Incidence is
gender. expressed as cases per 100,000 person-years.

IBD cases within a well-dened geographic area was close to

a diagnosis of UC. The age- and gender-adjusted prevalence 100%. The complete (inpatient and outpatient) community
rate was 214 cases per 100,000 (95% CI, 188 240) for UC medical record for all potential cases was available for re-
(Table 5) and 174 cases per 100,000 (95% CI, 151197) for view, and strict yet consistent diagnostic criteria were ap-
CD (Table 6). The age- and gender-adjusted prevalence rate plied. In addition, we were able to build on previous epide-
of CD in 2001 was 31% higher than that measured in 1991 miologic reports of CD3,6,36 and UC18,37,38 in Olmsted
(133 cases per 100,000; 95% CI, 111155),36 while the prev- County, extending the period of study to 61 years, and al-
alence rate of UC changed little from that measure in 1991 lowing further analysis of temporal trends in the incidence
(229 cases per 100,000; 95% CI, 198 260).36 and prevalence of these conditions. Therefore, this study
provides true population-based information on the frequency
DISCUSSION of CD and UC in a small region of the US.
The incidence of both CD and UC increased dramati- The corresponding limitations of this study include
cally in Olmsted County, Minnesota, between 1940 and the the fact that the population size of Olmsted County re-
early 1970s. Since then the rates have stabilized at 8 cases stricted the study to a relatively small number of cases. In
per 100,000 person-years for CD and 9 cases per 100,000 addition, as has been seen in previous epidemiologic re-
person-years for UC. The prevalence of CD increased by ports of this particular population, only limited follow-up
31% between 1991 and 2001. In comparison, during the same was available in some cases, due to incidence cases having
time period the prevalence rate of UC decreased by 7%. moved out of the county after diagnosis. Finally, our
Male gender and age and decade of diagnosis were associated results may not necessarily be representative of the re-
with changing rates of UC, while age and decade of diagnosis mainder of the US as a result of racial and ethnic differ-
were associated with the incidence of CD. ences.41 As of 2000, 89% of the residents of Olmsted
The main strength of this study is that ascertainment of County were non-Hispanic white, compared to 69% for the
rest of the US. These differences in racial and ethnic
distribution may be particularly important when extrapo-
TABLE 4. Age-specic Incidence of Crohns Disease, lating our CD incidence rates to the US as a whole, since
1940-2000, by Gender it is believed that the incidence rate of CD may be signif-
Age Group,
icantly lower among Hispanics and Asian Americans.43
Years Males Females Total The adjusted annual incidence rates of CD and UC for
the period 1990 2000 were 7.9 cases per 100,000 and 8.8 per
0-19 3.4 3.4 3.4 100,000, respectively. While these rates are historically high,
20-29 13.0 14.2 13.7 even higher rates have been described from other centers in
30-39 9.1 7.0 8.0 both North America and Europe during recent decades. The
40-49 5.7 6.1 5.9 incidence of CD was reported as 10 cases per 100,000 in
50-59 5.3 4.1 4.7 Alberta in 1981,7 while the incidence of UC in Northern
60-69 7.1 4.3 5.6 California was reported as 10.9 per 100,000.44 When com-
70 6.1 4.2 4.9 pared with crude rates obtained in 19911993 by the Euro-
Rates are expressed as cases per 100,000 person-years. pean Collaborative study of Inammatory Bowel Disease
(EC-IBD),45 the incidence rate of CD in Olmsted County was

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Inamm Bowel Dis Volume 13, Number 3, March 2007 Update on CD and UC in Olmsted County, MN

TABLE 5. Age- and Sex-specic and Adjusted Prevalence of Ulcerative Colitis, January 1, 2001, by Gender
Males Females Total

Age Group, years N Prevalence N Prevalence N Prevalence

0-19 25 133.3 14 78.6 39 106.7

20-29 41 522.0 38 465.2 79 493.0
30-39 33 332.0 35 349.1 68 340.6
40-49 27 276.5 17 166.6 44 220.4
50-59 13 207.1 7 104.0 20 153.7
60-69 8 205.3 3 71.2 11 135.7
70 3 80.1 5 83.1 8 82.0
Total 150 249.1 119 188.4 269 218.0
Age- and sex-adjusted (95% CI) 243.5 (188.2-239.6) 184.6 (151.4-217.8) 213.9 (188.2-239.6)
Prevalence is expressed as cases per 100,000 persons.

higher, while the incidence rate of UC was similar to the
mean rate reported by the European centers. The incidence
rates of CD and UC in the present study may be compatible
with previously reported observations of a northsouth gra-
dient of inammatory bowel disease within the US.46,47
The incidence of CD and UC reported in recent decades
is much higher than rates reported in the 1940s and 1950s.
Although intuitively one could attribute the rise to the intro-
duction of better diagnostic techniques for these conditions,
we do not believe that this factor alone explains the precip-
itous rise in incidence. The two major modalities used to
diagnose IBD over the past 60 years have been barium
radiography and colonoscopy. Barium radiography and proc-
toscopy were widely used in Olmsted County prior to the
rapid rise in incidence, while colonoscopy became available
after this rise had taken place. In addition, one might expect
a shorter interval between symptom onset and diagnosis if the
rise in incidence were due to increased healthcare-seeking or
better diagnostic techniques; while our group has previously
described such a trend in the patients with UC,37 this has not
been conrmed in patients with CD.36
In patients with UC, the distribution of age at diagnosis
differed between the sexes, with a persistently higher inci-
dence rate noted among men in the later decades of life (Fig.
2). In comparison, the distribution of age at diagnosis in CD
was more equally distributed between females and males
(Figure 4). Peak incidence for both CD and UC was noted in
the third decade of life. While the incidence of UC in men
demonstrated a bimodal distribution, this was not observed in
women with UC or in patients with CD.
The adjusted prevalence of CD on January 1, 2001
(174 cases per 100,000 persons) is one of the highest
reported and has increased by 31% over the past 10 years.
While the adjusted prevalence of UC remains high (214
cases per 100,000 persons), this gure has decreased by
7% over the same 10-year period. The rising prevalence of

TABLE 6. Age- and Sex-specic and Adjusted Prevalence of Crohns Disease, January 1, 2001, by Gender
Males Females Total

Age Group, Years N Prevalence N Prevalence N Prevalence

0-19 23 122.7 19 106.7 42 114.9

20-29 35 445.6 45 550.9 80 499.3
30-39 26 261.6 20 199.5 46 230.4
40-49 12 122.9 11 107.8 23 115.2
50-59 6 95.6 7 104.0 13 99.9
60-69 5 128.3 4 95.0 9 111.0
70 4 106.8 3 49.9 7 71.7
Total 111 184.3 109 172.6 220 178.3
Age- and sex-adjusted (95% CI) 179.7 (145.8-213.7) 169.4 (137.5-201.2) 173.8 (150.7-196.9)
Prevalence is expressed as cases per 100,000 persons.

259
Loftus et al
CD is likely a reection of prolonged survival due to the
availability of more advanced medical therapies. If the
results of this study are extrapolated to the US white
population of 2000 (220 million), there may have been
as many as 383,000 patients with CD and 471,000 patients
with UC among US whites at the beginning of the 21st
century. These gures are likely an underestimation of all
cases in the entire US population since African Americans,
who numbered 35 million in the 2000 census, may have
an incidence approaching that of US whites.43,44 It has
previously been projected that the prevalence of CD in
Olmsted County should eventually stabilize at roughly 250
cases per 100,000 persons.36 As the number of patients
with IBD in the US continues to grow, so too will health-
care costs associated with this population. This must re-
main a concern for those caring for patients with IBD in
this era of continually rising healthcare costs.
ACKNOWLEDGMENT
We thank Debra A. Jewell, RN, for assistance in data
abstraction.
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