Infections and Cardiovascular Complications are Common Causes for Hospitalization in Older Patients with Inflammatory Bowel Diseases

Abstract

Background and Aims Prevalence of inflammatory bowel diseases (IBD) in older patients is increasing. Risk-benefit trade-offs of therapy are poorly understood in older patients, who may be at higher risk of nonIBD and/or treatment-related complications, rather than disease-related complications. We conducted a nationally representative cohort study to estimate and compare annual burden, costs, and causes for hospitalization in older versus younger patients with IBD. Methods Using the Nationwide Readmissions Database 2013, we created a cohort of 47,402 patients with IBD who had been hospitalized at least once between January-June 2013 and followed for rehospitalization until December 2013. We estimated annual burden (total days spent in hospital), costs, and causes (based on primary discharge diagnosis) of hospitalization in older (>64y, n = 15,428), middle-age (40-64y, n = 18,476), and younger (<40y, n = 13,498) patients. Results Older patients with IBD spent more days in hospital annually [median interquartile range: 7 (3-13) days] than middle-age [6 (3-12) days], and younger patients [5 ([3-11) days], with significantly higher hospitalization-related costs $15,078 (7423-30,955) vs $12,921 (6367-28,182) vs.. $10,070 (5192-22,100), P < 0.01. Older patients were significantly more likely to be hospitalized due to serious infections (14.6% vs 10.6% vs 8.4%; P < 0.01) and cardiovascular complications (9.9% vs 4.3% vs 0.8%; P < 0.01), and they were less likely due to IBD-related complications (11.8% vs 23.5% vs 41.4%; P < 0.01). Conclusions Older IBD patients have higher burden and costs of hospitalization than younger patients, mainly attributed to serious infections and cardiovascular complications, rather than disease-related complications. Careful assessment of comparative risks-benefits of different IBD therapies in older patients is warranted to identify the optimal treatment approach.