TY - JOUR
T1 - Risk of Surgery and Mortality in Elderly-onset Inflammatory Bowel Disease
T2 - A Population-based Cohort Study
AU - Nguyen, Geoffrey C.
AU - Bernstein, Charles N.
AU - Benchimol, Eric I.
N1 - Funding Information:
Supported by an operating grant from the Canadian Institutes of Health Research (CIHR). G. C. Nguyen is supported by a New Investigator Award from CIHR and the Crohn's and Colitis Foundation of Canada. C. N. Bernstein is supported in part by the Bingham Chair in Gastroenterology. E. I. Benchimol is supported by a New Investigator Award from the CIHR, Canadian Association of Gastroenterology, and Crohn's and Colitis Canada as well as a Career Enhancement Program award from the Canadian Child Health Clinician Scientist Program. The sponsors had no role in any aspect of the study. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).
Publisher Copyright:
© Copyright 2016 Crohn's & Colitis Foundation of America, Inc.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background: As the prevalence of inflammatory bowel disease (IBD) increases in the elderly population, we sought to characterize IBD-related outcomes in this population. Methods: We identified incident IBD cases in Ontario, Canada between 1999 and 2008 and categorized subjects by age at diagnosis as young adults (18-40 yr); middle-age adults (41-64 yr); and elderly (≥65 yr) from within population-based health administrative data. We determined the risk of IBD-related surgery and mortality in those with elderly-onset IBD compared with other age groups. Results: Of 21,218 persons with IBD, there were 1749 cases of elderly-onset ulcerative colitis (UC) and 725 cases elderly-onset Crohn's disease (CD). Elderly UC had higher rates of IBD-related surgery than those with young-adult UC (adjusted hazard ratio, 1.34; 95% CI, 1.16-1.55), although there was no difference in surgical rates between age groups in CD. IBD-specific mortality was higher in elderly-onset CD (33.1/10,000 person-year) compared with that in middle-age CD (5.6/10,000 person-year, P < 0.0001) and young adult CD (1.0/10,000 person-year) but was not different by age in UC. The leading cause of death in elderly UC and CD was solid malignancies accounting for 22.9% and 26.4% of deaths, respectively, whereas IBD was third most frequent cause of death accounting for 6.3% and 9.1% of deaths, respectively. Conclusions: Elderly-onset patients with UC were more likely to undergo surgery while elderly-onset patients with CD exhibited higher IBD-specific mortality than those with younger-onset disease. These findings should prompt more optimized disease management in elderly IBD.
AB - Background: As the prevalence of inflammatory bowel disease (IBD) increases in the elderly population, we sought to characterize IBD-related outcomes in this population. Methods: We identified incident IBD cases in Ontario, Canada between 1999 and 2008 and categorized subjects by age at diagnosis as young adults (18-40 yr); middle-age adults (41-64 yr); and elderly (≥65 yr) from within population-based health administrative data. We determined the risk of IBD-related surgery and mortality in those with elderly-onset IBD compared with other age groups. Results: Of 21,218 persons with IBD, there were 1749 cases of elderly-onset ulcerative colitis (UC) and 725 cases elderly-onset Crohn's disease (CD). Elderly UC had higher rates of IBD-related surgery than those with young-adult UC (adjusted hazard ratio, 1.34; 95% CI, 1.16-1.55), although there was no difference in surgical rates between age groups in CD. IBD-specific mortality was higher in elderly-onset CD (33.1/10,000 person-year) compared with that in middle-age CD (5.6/10,000 person-year, P < 0.0001) and young adult CD (1.0/10,000 person-year) but was not different by age in UC. The leading cause of death in elderly UC and CD was solid malignancies accounting for 22.9% and 26.4% of deaths, respectively, whereas IBD was third most frequent cause of death accounting for 6.3% and 9.1% of deaths, respectively. Conclusions: Elderly-onset patients with UC were more likely to undergo surgery while elderly-onset patients with CD exhibited higher IBD-specific mortality than those with younger-onset disease. These findings should prompt more optimized disease management in elderly IBD.
KW - Crohn's disease
KW - elderly
KW - inflammatory bowel disease
KW - ulcerative colitis
UR - http://www.scopus.com/inward/record.url?scp=85006459487&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85006459487&partnerID=8YFLogxK
U2 - 10.1097/MIB.0000000000000993
DO - 10.1097/MIB.0000000000000993
M3 - Article
C2 - 27997435
AN - SCOPUS:85006459487
SN - 1078-0998
VL - 23
SP - 218
EP - 223
JO - Inflammatory bowel diseases
JF - Inflammatory bowel diseases
IS - 2
ER -