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Risk of Surgery and Mortality in Elderly-onset Inflammatory Bowel Disease: A Population-based Cohort Study

Nguyen, Geoffrey C. MD, PhD; Bernstein, Charles N. MD; Benchimol, Eric I. MD, PhD

doi: 10.1097/MIB.0000000000000993
Original Clinical Article

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.

Article first published online 16 December 2016.

*Department of Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Ontario, Canada;

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;

Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada;

§University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre and

Department of Internal Medicine, Winnipeg, Canada; and

Children's Hospital of Eastern Ontario IBD Centre, Department of Pediatrics, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Address correspondence to: Geoffrey C. Nguyen, MD, PhD, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, 600 University Avenue, Suite 437, Toronto, ON M5G 1X5, Canada (e-mail: geoff.nguyen@utoronto.ca).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).

C. N. Bernstein has participated in advisory boards for AbbVie Canada, Janssen Canada, Pfizer Canada, Shire Canada, Takeda Canada and has consulted to Mylan Pharmaceuticals. He has received unrestricted educational grants from AbbVie Canada, Janssen Canada, Shire Canada and Takeda Canada. The remaining authors have no conflict of interest to disclose.

The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

Received September 28, 2016

Accepted October 31, 2016

© Crohn's & Colitis Foundation of America, Inc.
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