Epidemiology of Elderly Onset IBD: A Nationwide Population-Based Cohort Study.

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Clinical Gastroenterology and Hepatology Pub Date : 2024-08-30 DOI:10.1016/j.cgh.2024.08.011
Siddharth Singh, Gry Juul Poulsen, Tania Hviid Bisgaard, Linéa Bonfils, Tine Jess
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Abstract

Background and aims: We examined the incidence and natural history of patients with very elderly onset (herein referred to as very late-onset) inflammatory bowel diseases (IBDs) (≥ 70 years of age at diagnosis), compared with patients diagnosed between 60 and 69 years of age in Denmark.

Methods: In the Danish National Patient Register, between 1980 and 2018, we identified all individuals ≥ 60 years of age with newly diagnosed Crohn's disease (CD) and ulcerative colitis (UC) and examined trends in incidence, cumulative risk of hospitalization, treatment patterns, IBD-related surgery, serious infection, cancer and cardiovascular and venous thromboembolic risks among very late-onset (70-79 years of age or 80+ years) vs late-onset (60-69 years of age) IBD, using nonparametric competing risk analysis treating death as competing risk.

Results: We identified 3459 patients with onset of CD at ≥60 years of age (47% ≥ 70 years of age) and 10,774 patients with onset of UC ≥60 years of age (51% ≥ 70 years of age). Over the last 3 decades, incidence changes for very late-onset and late-onset IBD have followed the same patterns. Also, both for CD and UC, cumulative incidence of IBD-related hospitalization and corticosteroid use was comparable in very late-onset vs late-onset patients. However, the burden of disease-modifying therapy, either immunomodulator or tumor necrosis factor antagonist use, and major IBD-related surgery was significantly lower in patients with very late-onset than in late-onset IBD. On the other hand, the 5-year risk of serious infections and cardiovascular events was higher in patients with very late-onset IBD.

Conclusions: This nationwide cohort study shows that patients diagnosed with very late-onset (≥ 70 years of age) IBD have a higher relative burden of disease- and aging-related complications, with limited use of steroid-sparing strategies and surgery, compared with late-onset IBD.

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老年 IBD 流行病学:一项基于全国人口的队列研究。
背景和目的:我们研究了在丹麦,与60-69岁之间确诊的炎症性肠病(IBD)患者相比,高龄发病(此处称为极晚期发病)患者(确诊时年龄≥70岁)的发病率和自然史:在1980-2018年间的丹麦全国患者登记册中,我们确定了所有年龄≥60岁的新确诊克罗恩病(CD)和溃疡性结肠炎(UC)患者,并采用非参数竞争风险分析方法(将死亡作为竞争风险),研究了极晚期(70-79岁或80岁以上)与晚期(60-69岁)IBD患者的发病率、住院累积风险、治疗模式、IBD相关手术、严重感染、癌症以及心血管和静脉血栓栓塞风险的趋势:我们发现 3459 名 CD 患者发病年龄≥60 岁(47%≥70 岁),10774 名 UC 患者发病年龄≥60 岁(51%≥70 岁)。在过去三十年中,极晚期和晚期 IBD 的发病率变化遵循相同的模式。此外,对于 CD 和 UC,极晚期发病患者与晚期发病患者的 IBD 相关住院和皮质类固醇使用的累积发病率相当。然而,极晚期 IBD 患者接受疾病调节治疗、使用免疫调节剂或 TNF 拮抗剂以及接受与 IBD 相关的大型手术的负担明显低于晚期 IBD 患者。另一方面,极晚期IBD患者发生严重感染和心血管事件的5年风险较高:这项全国范围的队列研究表明,与晚发性 IBD 相比,确诊为极晚发(≥70 岁)IBD 患者的疾病和衰老相关并发症的相对负担较高,且类固醇节约策略和手术的使用有限。
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来源期刊
CiteScore
16.90
自引率
4.80%
发文量
903
审稿时长
22 days
期刊介绍: Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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