感染和心血管并发症是老年炎症性肠病患者住院的常见原因。
Infections and Cardiovascular Complications are Common Causes for Hospitalization in Older Patients with Inflammatory Bowel Diseases.
机构信息
Department of Internal Medicine, University of California San Diego, La Jolla, California.
Division of Biomedical Informatics, University of California San Diego, La Jolla, California.
出版信息
Inflamm Bowel Dis. 2018 Mar 19;24(4):916-923. doi: 10.1093/ibd/izx089.
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.
背景和目的
炎症性肠病（IBD）在老年患者中的患病率正在增加。老年患者对治疗的风险效益权衡了解甚少，他们可能面临更高的非 IBD 和/或与治疗相关的并发症风险，而不是与疾病相关的并发症风险。我们进行了一项全国代表性队列研究，以估计和比较老年与年轻 IBD 患者的住院年度负担、成本和住院原因。
方法
我们使用 2013 年全国再入院数据库，创建了一个队列，该队列包括至少在 2013 年 1 月至 6 月期间住院一次的 47402 例 IBD 患者，并对他们进行了重新住院的随访，直到 2013 年 12 月。我们估计了老年（>64 岁，n=15428）、中年（40-64 岁，n=18476）和年轻（<40 岁，n=13498）患者的住院年度负担（总住院天数）、成本和住院原因（基于主要出院诊断）。
结果
与中年患者（中位数四分位距：7[3-13]天）和年轻患者（5[3-11]天）相比，老年 IBD 患者每年住院时间更长[7（3-13）天]，且住院相关费用更高，分别为$15078（7423-30955）、$12921（6367-28182）和$10070（5192-22100），P<0.01。老年患者因严重感染（14.6%比 10.6%比 8.4%，P<0.01）和心血管并发症（9.9%比 4.3%比 0.8%，P<0.01）住院的可能性显著更高，而因 IBD 相关并发症住院的可能性显著更低（11.8%比 23.5%比 41.4%，P<0.01）。
结论
老年 IBD 患者的住院负担和费用高于年轻患者，主要归因于严重感染和心血管并发症，而不是与疾病相关的并发症。有必要仔细评估老年患者不同 IBD 治疗方法的相对风险效益，以确定最佳治疗方法。
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