老年起病型炎症性肠病的手术风险与死亡率：一项基于人群的队列研究。

Risk of Surgery and Mortality in Elderly-onset Inflammatory Bowel Disease: A Population-based Cohort Study.

作者信息

Nguyen Geoffrey C, Bernstein Charles N, Benchimol Eric I

机构信息

*Department of Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Ontario, Canada; †Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; ‡Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada; §University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre and ‖Department of Internal Medicine, Winnipeg, Canada; and ¶Children's Hospital of Eastern Ontario IBD Centre, Department of Pediatrics, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.

出版信息

Inflamm Bowel Dis. 2017 Feb;23(2):218-223. doi: 10.1097/MIB.0000000000000993.

DOI:10.1097/MIB.0000000000000993

PMID:27997435

Abstract

BACKGROUND

As the prevalence of inflammatory bowel disease (IBD) increases in the elderly population, we sought to characterize IBD-related outcomes in this population.

METHODS

We identified incident IBD cases in Ontario, Canada between 1999 and 2008 and categorized subjects by age at diagnosis as young adults (18-40 yr); middle-age adults (41-64 yr); and elderly (≥65 yr) from within population-based health administrative data. We determined the risk of IBD-related surgery and mortality in those with elderly-onset IBD compared with other age groups.

RESULTS

Of 21,218 persons with IBD, there were 1749 cases of elderly-onset ulcerative colitis (UC) and 725 cases elderly-onset Crohn's disease (CD). Elderly UC had higher rates of IBD-related surgery than those with young-adult UC (adjusted hazard ratio, 1.34; 95% CI, 1.16-1.55), although there was no difference in surgical rates between age groups in CD. IBD-specific mortality was higher in elderly-onset CD (33.1/10,000 person-year) compared with that in middle-age CD (5.6/10,000 person-year, P < 0.0001) and young adult CD (1.0/10,000 person-year) but was not different by age in UC. The leading cause of death in elderly UC and CD was solid malignancies accounting for 22.9% and 26.4% of deaths, respectively, whereas IBD was third most frequent cause of death accounting for 6.3% and 9.1% of deaths, respectively.

CONCLUSIONS

Elderly-onset patients with UC were more likely to undergo surgery while elderly-onset patients with CD exhibited higher IBD-specific mortality than those with younger-onset disease. These findings should prompt more optimized disease management in elderly IBD.

摘要

背景

随着老年人群中炎症性肠病（IBD）患病率的上升，我们试图描述该人群中与IBD相关的结局。

方法

我们在加拿大安大略省确定了1999年至2008年期间的新发IBD病例，并根据基于人群的健康管理数据，将诊断时的年龄分为青年成人（18 - 40岁）、中年成人（41 - 64岁）和老年人（≥65岁）。我们确定了老年起病的IBD患者与其他年龄组相比，IBD相关手术和死亡的风险。

结果

在21218例IBD患者中，有1749例老年起病的溃疡性结肠炎（UC）和725例老年起病的克罗恩病（CD）。老年UC患者IBD相关手术率高于青年成人UC患者（校正风险比，1.34；95%可信区间，1.16 - 1.55），尽管CD患者各年龄组之间手术率无差异。老年起病的CD患者IBD特异性死亡率（33.1/10000人年）高于中年CD患者（5.6/10000人年，P < 0.0001）和青年成人CD患者（1.0/10000人年），但UC患者的死亡率在各年龄组之间无差异。老年UC和CD患者的主要死亡原因是实体恶性肿瘤，分别占死亡人数的22.9%和26.4%，而IBD分别是第三常见的死亡原因，占死亡人数的6.3%和9.1%。