Inflammatory bowel disease in the elderly is associated with worse outcomes: a national study of hospitalizations

Abstract

Background: Inflammatory bowel disease (IBD) has a bimodal peak of incidence with approximately 15% of the cases manifesting after 65 years. Previous reports on the outcomes of IBD in the elderly have been single-center studies or have predated the use of biologics. The aim of our study was to compare outcomes of IBD-related hospitalizations in a nationwide representative cohort of patients 65 years and older with younger patients.

Methods: This was a cross-sectional study utilizing data from the Nationwide Inpatient Sample (NIS) for the year 2004. We identified all IBD-related hospitalizations through the presence of the appropriate ICD-9-CM codes for Crohn's disease, ulcerative colitis, or associated complications. We compared the differences in disease presentation as well the frequency of utilization of different interventions. We calculated the adjusted odds of mortality in older compared to the younger IBD patients using multivariate logistic regression.

Results: Patients older than 65 years accounted for approximately 25% of all IBD-related hospitalizations in 2004. They were less likely to be hospitalized with fistulizing (4.0 versus 8.8%, P < 0.001) or stricturing disease (4.0 versus 5.8%, P = 0.001). Even after adjusting for comorbidity, they had higher in-hospital mortality (odds ratio [OR] 3.91, 95% confidence interval [CI] 2.50-6.11). Older patients with fistulizing disease are more likely to undergo surgery (OR 1.55, 95% CI 1.00-2.40). Among IBD patients who underwent surgery, older patients also had a longer postoperative stay (1.73 days, 95% CI 1.04-2.21).

Conclusions: Older patients with IBD-related hospitalizations have substantial morbidity and higher mortality than younger patients. Further research is needed to better characterize the natural history and treatment outcomes in this cohort.