Prevalence and age trends in home enteral nutrition: A nationwide, ten-year analysis of nearly 40,000 patients.
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BACKGROUND AND AIMS: Home enteral nutrition (HEN) is essential for patients unable to meet nutritional requirements orally. Despite growing utilization worldwide, longitudinal population-level data examining trends in prevalence, demographics, and costs remain scarce, with no published nationwide trend analyses. We aimed to assess temporal trends in HEN prevalence, demographic shifts, clinical indications, healthcare expenditures, and one-year crude mortality proportion over a decade (2010-2020) using comprehensive national health insurance data. METHODS: Retrospective analysis of anonymized administrative claims covering all reimbursed adult HEN from a centralized national health fund. Trends were evaluated using Mann-Kendall tests with Theil-Sen estimators. Indications were classified by ICD-10. Costs were analyzed in euros and adjusted for inflation and purchasing power parity. Given the aggregated administrative data structure, analyses were limited to population-level trend assessment without patient-level confounder adjustment. RESULTS: Among 37,667 patients, annual prevalence increased 5.11-fold, from 62.7 to 322.5 per million inhabitants (p < 0.0001). A significant demographic shift occurred: the proportion of new patients aged 18-64 years declined from 49.6% to 35.8%, while those aged 65-74 years increased from 20.3% to 30.9% and those ≥85 years from 9.7% to 15.0%. Neurological disorders (28.1%) and malignancies (24.3%) were the predominant indications. Per-patient HEN costs rose significantly (€3,165 to €4,108; p = 0.0006), while total treatment costs per patient remained stable. No change in the one-year crude mortality proportion (57%) was observed. CONCLUSIONS: HEN utilization expanded rapidly with a pronounced shift toward older recipients. Rising nutrition-specific costs alongside high early mortality underscore the need for capacity planning and outcome-oriented policies in aging populations.