Characterization of Inflammatory Bowel Disease in Hospitalized Elderly Patients in a Large Central Canadian Health Region

Stepaniuk, Peter; Bernstein, Çharles N.; Nugent, Zoann; Singh, Harminder

doi:10.1155/2015/724359

Cited by 22 publications

(11 citation statements)

References 13 publications

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“…While International Classification of Disease codes have been used in other studies examining the relationship between cardiovascular disease and IBD, 17,18,21,27,28,30,42 the NIS does not contain personal identifiers, and thus we are unable to validate the ICD-9-CM diagnosis codes of individual patients using chart review. ICD-9-CM coding has demonstrated accuracy in IBD 47,48 and other studies of gastrointestinal disorders, 49 however this remains a concern in our population given mixed performance within studies of patients with IBD in the Veterans Affairs system. 50,51 There also exists the potential for underdiagnosis of other risk factors, particularly tobacco use and obesity.…”

Section: Discussionmentioning

confidence: 93%

Hospitalizations for Acute Myocardial Infarction Are Decreased Among Patients with Inflammatory Bowel Disease Using a Nationwide Inpatient Database

Barnes

Beery

Schulman

et al. 2016

Inflammatory Bowel Diseases

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Background: Questions remain regarding the true prevalence of cardiovascular events such as myocardial infarction (MI) among patients with Inflammatory Bowel Disease (IBD). Using the Nationwide Inpatient Sample (NIS), we aimed to compare the proportion of hospitalizations for acute MI among patients with IBD to that of the general population. Methods: This study used data from years 2000–2011 in NIS, the largest publicly available all-payer inpatient database in the US. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) discharge codes were used to identify adult patients with discharge diagnoses of IBD (Ulcerative Colitis or Crohn’s Disease), acute MI, and multiple comorbid risk factors for cardiovascular disease. The independent effect of a diagnosis of IBD on risk of acute MI was examined using a multivariable logistic regression model controlling for multiple confounders. Data were analyzed using SAS survey procedures and weighted to reflect national estimates. Results: We identified 567,438 hospitalizations among patients with IBD and 78,121,000 hospitalizations among the general population. Patients with IBD were less likely to be hospitalized for acute MI than patients in the general population (1.3% vs. 3.1%, p<0.001). In adjusted analyses, the odds of hospitalization for acute MI among patients with IBD were decreased when compared to the general population (OR 0.51, 95% CI 0.50 – 0.52). Conclusions: Despite prior reports of a potentially increased risk of acute MI among patients with IBD, in a nationwide inpatient database, lower rates of acute MI were demonstrated in the IBD population when compared to the general population.

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Section: Discussionmentioning

confidence: 93%

Hospitalizations for Acute Myocardial Infarction Are Decreased Among Patients with Inflammatory Bowel Disease Using a Nationwide Inpatient Database

Barnes

Beery

Schulman

et al. 2016

Inflammatory Bowel Diseases

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“…However, other studies using the same CCI have shown a wide range of comorbidity prevalence. In these studies, the prevalences ranged from less than one fifth to more than two thirds of the included patients with one or more comorbidities 12,23 …”

Section: Discussionmentioning

confidence: 99%

Comorbidity, not patient age, is associated with impaired safety outcomes in vedolizumab‐ and ustekinumab‐treated patients with inflammatory bowel disease—a prospective multicentre cohort study

Asscher

Biemans

Pierik

et al. 2020

Aliment Pharmacol Ther

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Summary Background Few data are available on the effects of age and comorbidity on treatment outcomes of vedolizumab and ustekinumab in inflammatory bowel disease (IBD). Aims To evaluate the association between age and comorbidity with safety and effectiveness outcomes of vedolizumab and ustekinumab in IBD. Methods IBD patients initiating vedolizumab or ustekinumab in regular care were enrolled prospectively. Comorbidity prevalence was assessed using the Charlson Comorbidity Index (CCI). Association between age and CCI, both continuously assessed, with safety outcomes (any infection, hospitalisation, adverse events) during treatment, and effectiveness outcomes (clinical response and remission, corticosteroid‐free remission, clinical remission combined with biochemical remission) after 52 weeks of treatment were evaluated. Multivariable logistic regression was used to adjust for confounders. Results We included 203 vedolizumab‐ and 207 ustekinumab‐treated IBD patients, mean age 42.2 (SD 16.0) and 41.6 (SD 14.4). Median treatment duration 54.0 (IQR 19.9‐104.0) and 48.4 (IQR 24.4‐55.1) weeks, median follow‐up time 104.0 (IQR 103.1‐104.0) and 52.0 weeks (IQR 49.3‐100.4). On vedolizumab, CCI associated independently with any infection (OR 1.387, 95% CI 1.022‐1.883, P = 0.036) and hospitalisation (OR 1.586, 95% CI 1.127‐2.231, P = 0.008). On ustekinumab, CCI associated independently with hospitalisation (OR 1.621, 95% CI 1.034‐2.541, P = 0.035). CCI was not associated with effectiveness, and age was not associated with any outcomes. Conclusions Comorbidity ‐ but not age ‐ is associated with an increased risk of hospitalisations on either treatment, and with any infection on vedolizumab. This underlines the importance of comorbidity assessment and safety monitoring of IBD patients.

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“…In evaluations of administrative databases of adults, a single ICD-10 code has been accurate in the identification of patients with UC and CD. 45 Additionally, the KID database allows for cross-sectional analyses only, and thus we were unable to evaluate or account for the potential that a single patient could be admitted multiple times during the course of the study period. Our inability to evaluate readmissions is a significant limitation, particularly given that those patients with the longest LOS are likely the same individuals who are most likely to be readmitted within 30 or 90 days of their index hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

Barnes¹,

Kochar²,

Long³

et al. 2017

Inflammatory Bowel Diseases

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Background Genetic and other biological factors may lead to differences in disease behavior among children with inflammatory bowel disease from different races, which may be further modified by disparities in care delivery. Using the Kids' Inpatient Database (KID), we aimed to evaluate differences in the management of pediatric patients with IBD by race, focusing on length of stay. Methods We performed a cross-sectional analysis using 2000-2012 data from KID, a nationally representative database. We identified pediatric patients (< 18 years of age) with discharge diagnoses of Crohn's disease (CD) or ulcerative colitis (UC). We used multivariable logistic regression to evaluate the relationship between race and length of stay (LOS), controlling for age, payer status need for surgery, and year of admission. Results We identified 27,295 hospitalizations for children with IBD (62% CD and 38% UC), Compared to white patients with CD, black [adjusted odds ratio (aOR) 1.37, 95% CI:1.22–1.53, p<0.001) and Hispanic patients (aOR 1.37, 95%CI:1.19–1.59, p<0.001) with CD demonstrated increased odds of a LOS greater than the 75th percentile. When compared to white patients with UC, Hispanic patients also demonstrated increased odds of a LOS greater than the 75th percentile (aOR 1.20, 95% CI:1.02–1.42, p=0.015). Conclusions After controlling for age, year of admission, and clinical phenotypes, black and Hispanic patients with CD and Hispanic patients with UC had longer LOS than white patients. These may be due to differences in provider/hospital characteristics, socioeconomic differences, and/or differences in genetics and other biological factors.

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Characterization of Inflammatory Bowel Disease in Hospitalized Elderly Patients in a Large Central Canadian Health Region

Abstract: Treatment approaches in elderly patients were different than in younger IBD patients despite having disease sufficiently severe to require hospitalization. While less accurate in UC, a single ICD-10 IBD code was sufficient to identify elderly CD and UC hospitalized patients.

Cited by 22 publications

References 13 publications

Hospitalizations for Acute Myocardial Infarction Are Decreased Among Patients with Inflammatory Bowel Disease Using a Nationwide Inpatient Database

Hospitalizations for Acute Myocardial Infarction Are Decreased Among Patients with Inflammatory Bowel Disease Using a Nationwide Inpatient Database

Comorbidity, not patient age, is associated with impaired safety outcomes in vedolizumab‐ and ustekinumab‐treated patients with inflammatory bowel disease—a prospective multicentre cohort study

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

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