Geriatric IBD mortality trend highlights need for ‘more standardized guidelines’
SAN ANTONIO — The odds of inpatient mortality were nearly four times higher among geriatric adults than adults aged younger than 75 years who were admitted to a hospital primarily for inflammatory bowel disease, according to data presented at the American College of Gastroenterology Annual Meeting.
The data further showed that the disparity in mortality was more than double the mortality difference of geriatric vs. nongeriatric patients with non-IBD hospital admissions. The findings underscore the importance of developing “more standardized guidelines and quality metrics tailored to the unique needs of the elderly population,” Jeffrey Schwartz, MD, physician in the division of internal medicine at Beth Israel Deaconess Medical Center, and colleagues reported.
“The population of the United States is aging, and this trend is only expected to accelerate over the coming decades,” Schwartz said during a presentation. “This obviously has very significant implications for our health care system as a whole, but it also has implications for our management of IBD.”
Geriatric patients with IBD face several “unique challenges,” Schwartz said. These patients are more likely to have a higher comorbidity burden and worse nutritional status, making them “generally poor surgical candidates,” he added. Additionally, geriatric patients are less able to tolerate steroids and immunosuppressants, and have a greater risk for malignancy, infection and other complications. They are also more likely to be hospitalized with disease relapse.
“When they are hospitalized, they are more likely to experience certain complications like [Clostridioides difficile] and venous thrombotic events,” Schwartz said. “However, in spite of this increased complication rate, there are limited data about the effect of geriatric status on inpatient mortality, and that is what we hope to tackle in our study.”
Schwartz and colleagues used data from a 20% stratified sample of all inpatient discharges from 2016 in the United States to assess the impact of geriatric status on inpatient mortality. The researchers limited their analysis to adults aged 18 years or older. Patients aged older than 75 years were considered geriatric.
There were approximately 30 million inpatient admissions in 2016, according to Schwartz. More than 71,000 patients were admitted for Crohn’s disease, including 10,905 geriatric patients. Nearly 36,000 patients were admitted for ulcerative colitis, including 8,285 geriatric patients.
In a multivariate analysis adjusted for comorbidities, surgery and the presence of C. diff, nongeriatric status was associated with a lower odds of inpatient mortality among patients with Crohn’s disease (adjusted OR = 0.25; 95% CI, 0.11-0.59) and ulcerative colitis (aOR = 0.19; 95% CI, 0.08-0.44). When looking at all hospital admissions, there was a similar trend of lower inpatient mortality among nongeriatric patients vs. geriatric patients (aOR = 0.5; 95% CI, 0.49-0.5).
“However, this trend is obviously of much less significant magnitude than the IBD population,” Schwartz said.
There were no significant differences in secondary endpoints, which included length of hospital stay and total inpatient charges.
Schwartz noted several limitations to the study, including the lack of data on disease history, disease severity and outpatient medications.
“In spite of these limitations, it is certainly our hope that the use of a nationwide population dataset illuminates a clinically important association between inpatient mortality and older age among IBD patients, notably without any increase in resource utilization,” he said. “Given the high prevalence of IBD patients who require inpatient admission, as well as the overall rapidly aging nature of the U.S. population, it is our hope that this study will provide some insight to drive ongoing efforts to improve guideline-directed therapy and propose interventions to help close this very important gap in clinical care.” – by Stephanie Viguers
Schwartz J, et al. Abstract 42. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosure: Schwartz reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.