The clinical practice of ulcerative colitis in elderly patients: An investigation using a nationwide database in Japan

Abstract

Background and Aim The number of elderly patients with ulcerative colitis (UC) is increasing worldwide. The clinical practice of associated treatment is still unclear. Therefore, we aimed to analyze clinical treatment realities and mortality in elderly and non‐elderly patients with UC. Methods We collected UC patients' data using the diagnosis procedure combination (DPC) database system and divided eligible patients into elderly (≥65 years) and non‐elderly (≤64 years) groups. We investigated and compared their therapeutic histories (medical treatments vs. surgery). Logistic regression analysis was conducted to identify clinical factors affecting surgery and in‐hospital death in each group. Results The rates of systemic steroid injection, molecular targeting drug usage, and surgery were not different between the two age groups. Meanwhile, the rate of in‐hospital death in elderly patients was higher than that in non‐elderly patients (2.7% vs. 0.19%, P < 0.0001). Multivariate analysis revealed that lower body mass index, treatment at an academic hospital, smoking history, molecular targeting drug use, and treatment with systemic steroid injection affected the rate of surgery in the elderly group. Multivariate analysis also revealed that male and older age affected the rate of in‐hospital death in the elderly group. Similar tendencies were also recognized in the non‐elderly group. Conclusions The clinical practice of treating elderly patients with UC is overall not different from treating non‐elderly patients with UC. Although the form of medical treatment and surgery rate for elderly patients with UC may not be significantly different from non‐elderly patients, the rate of in‐hospital death for elderly patients is higher.

Analysis of the disease activity of ulcerative colitis with and without concomitant primary sclerosing cholangitis: An investigation using a nationwide database in Japan

“…Physicians input patient diagnoses into the database according to the International Classification of Diseases, Tenth revision (ICD‐10). The DPC database has been used for various clinical studies to date, 24,25 and its diagnostic validity is recognized 23 …”

Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

“…In late-onset UC studies, whether referral center- or population-based, anti-tumor necrosis factor (anti-TNF) therapies were administered in the first 3–5 years to a minority (5–12%) of older patients with UC compared with 14–16% of patients with adult-onset disease [ 4 , 15 , 17 ], whereas a similar use of anti-TNF was reported in older UC patients with longstanding disease [ 45 , 46 ].…”

Clinical characteristics of ulcerative colitis in elderly patients

“…There are many reports that the hospitalization rate of elderly UC patients is significantly higher than that of non‐elderly UC patients 12,19,20 . In an accompanying article by Moroi et al (a Nationwide Study from Japan), the rate of in‐hospital death of elderly patients is higher 21 . One of the reasons of worse outcomes is that older‐onset UC patients have less chances of receiving strong immunosuppressive therapies considering the comorbidities and adverse events such as infections.…”