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- Everhov, Åsa H., et al.
(author)
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Incidence and Treatment of Patients Diagnosed With Inflammatory Bowel Diseases at 60 Years or Older in Sweden
- 2018
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In: Gastroenterology. - : Saunders Elsevier. - 0016-5085 .- 1528-0012. ; 154:3, s. 518-528
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Journal article (peer-reviewed)abstract
- BACKGROUND & 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.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, less than 18 years; adults, 18-59 years; elderly, 60 years or older).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 Crohn's 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 to patients with pediatric or adult onset, 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) (P<.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 to diagnosis at a younger age. The large differences in pharmacological treatment of adults and elderly patients are not necessarily due to a milder course of disease and warrant further investigation.
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| 2. |
- Everhov, Åsa H., et al.
(author)
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Sick Leave and Disability Pension in Prevalent Patients With Crohn's Disease
- 2018
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In: Journal of Crohn's & Colitis. - : Elsevier. - 1873-9946 .- 1876-4479. ; 12:12, s. 1418-1428
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Journal article (peer-reviewed)abstract
- Background and Aims: Crohn's disease may affect the ability to work and lead to permanent disability. We aimed to investigate work loss in prevalent patients.Methods: We identified patients with Crohn's disease and general population comparators matched by sex, birth year, healthcare region and education. We assessed days of sick leave and disability pension retrieved from the Swedish Social Insurance Agency and estimated the absolute and relative risk of receiving disability pension [minimum 25% work impairment].Results: In 2014, the 20638 Crohn's disease patients [median age 44 years] had more than twice as many mean lost workdays [disability pension: 44; sick leave: 19] as the 102038 comparators [disability pension: 20; sick leave: 8], mean difference 35 days [95% confidence interval 33-37]. However, the majority had no lost workdays [68% of patients and 85% of comparators]. The proportion of patients receiving disability pension was 15% (6.5% in the comparators, risk ratio 2.34 [2.25-2.43]) and was higher in all subgroups, especially in female patients [28% vs 13% in the comparators], in those with ≤9 years of education [41% vs 23%] and in ages 60-64 years [46% vs 25%]. The relative risk of disability pension within the patient cohort [adjusted for age, sex, region and education] was higher in patients with complicated disease behaviour, extraintestinal manifestations, need of surgery or treatment with biologics. The differences between patients and comparators remained when comparing other calendar years [2006-2013].Conclusion: Work loss was found in approximately one-third of patients. The mean number of lost workdays was twice as high as in the comparators.
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| 3. |
- Nordenvall, Caroline, et al.
(author)
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Surgical treatment in childhood-onset inflammatory bowel disease : A nationwide register-based study of 4695 incident patients in Sweden 2002-2014
- 2018
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In: Journal of Crohn's & Colitis. - : Oxford University Press. - 1873-9946 .- 1876-4479. ; 12:2, s. 157-166
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Journal article (peer-reviewed)abstract
- Background and Aims: The incidence of childhood-onset (<18 years) inflammatory bowel disease is increasing worldwide, and some studies suggest that it represents a more severe disease phenotype. Few nationwide, population-based studies have evaluated the surgical burden in patients with childhood-onset IBD, and whether the improved medical treatment has influenced the need for gastrointestinal surgery. The aim was to examine whether the surgical treatment at any age of patients with childhood-onset IBD has changed over time.Methods: In a nationwide cohort study we identified 4,695 children (<18 years) diagnosed with incident IBD in 2002-2014 through the Swedish Patient Register (ulcerative colitis: n=2,295; Crohn's disease: n=2,174; inflammatory bowel disease-unclassified: n=226). Abdominal (intestinal resections and colectomies) and perianal surgery were identified through the Swedish Patient Register. The cumulative incidences of surgeries were calculated using the Kaplan Meier method.Results: In the cohort, 44% were females and 56% males. The median age at inflammatory bowel disease diagnosis was 15 years and the maximum age at end of follow-up was 31 years. The three-year cumulative incidence of intestinal surgery was 5% in patients with ulcerative colitis and 7% in patients with Crohn's disease, and lower in children <6 years at inflammatory bowel disease diagnosis (3%) than in those aged 15-17 years at diagnosis (7%). Calendar period of inflammatory bowel disease diagnosis was not associated with risk of surgery.Conclusion: Over the last 13 years, the risk of surgery in childhood-onset inflammatory bowel disease has remained unchanged.
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