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Incidence and Treatment of Patients Diagnosed With Inflammatory Bowel Diseases at 60 Years or Older in Sweden
Karolinska Inst, Sweden.
Örebro Univ, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
Karolinska Inst, Sweden.
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2018 (English)In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 154, no 3, p. 518-+Article in journal (Refereed) Published
Abstract [en]

BACKGROUND amp; AIMS: Diagnosis of inflammatory bowel diseases (IBD) is increasing among elderly persons (60 years or older). We performed a nationwide population-based study to estimate incidence and treatment of IBD. METHODS: We identified all incident IBD cases in Sweden from 2006 through 2013 using national registers and up to 10 matched population comparator subjects. We collected data on the patients health care contacts and estimated incidence rates, health service burden, pharmacologic treatments, extra-intestinal manifestations, and surgeries in relation to age of IBD onset (pediatric, amp;lt;18 years; adults, 18-59 years; elderly, amp;gt;= 60 years). RESULTS: Of 27,834 persons diagnosed with incident IBD, 6443 (23%) had a first diagnosis of IBD at 60 years or older, corresponding to an incidence rate of 35/100,000 person-years (10/100,000 person-years for Crohns disease, 19/100,000 person-years for ulcerative colitis, and 5/100,000 person-years for IBD unclassified). During a median follow-up period of 4.2 years (range, 0-9 years), elderly patients had less IBD-specific outpatient health care but more IBD-related hospitalizations and overall health care use than adult patients with IBD. Compared with patients with pediatric or adult-onset IBD, elderly patients used fewer biologics and immunomodulators but more systemic corticosteroids. Occurrence of extra-intestinal manifestations was similar in elderly and adult patients, but bowel surgery was more common in the elderly (13% after 5 years vs 10% in adults) (Pamp;lt;.001). The absolute risk of bowel surgery was higher in the elderly than in the general population, but in relative terms, the risk increase was larger in younger age groups. CONCLUSIONS: In a nationwide cohort study in Sweden, we associated diagnosis of IBD at age 60 years or older with a lower use of biologics and immunomodulators but higher absolute risk of bowel surgery, compared with diagnosis at a younger age. The large differences in pharmacologic treatment of adults and elderly patients are not necessarily because of a milder course of disease and warrant further investigation.

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC , 2018. Vol. 154, no 3, p. 518-+
Keywords [en]
CD; UC; Age Differences; Bowel Resection; Colectomy
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:liu:diva-145792DOI: 10.1053/j.gastro.2017.10.034ISI: 000424741500025PubMedID: 29102619OAI: oai:DiVA.org:liu-145792DiVA, id: diva2:1192401
Note

Funding Agencies|Swedish Medical Society (fund for research in gastroenterology); Swedish Medical Society (Ihre foundation); Mag-tarmfonden; Jane and Dan Olsson foundation; Mjolkdroppen foundation; Swedish Foundation for Strategic Research; Swedish Research Council; Swedish Cancer Society; Bengt Ihre research fellowship in gastroenterology; Karolinska Institutet foundations; Stockholm County Council; Karolinska Institutet (ALF); Janssen Pharmaceutica NV

Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2018-03-22

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Myrelid, Pär
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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDepartment of Surgery in Linköping
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