Singh Siddharth, Poulsen Gry Juul, Bisgaard Tania Hviid, Bonfils Linéa, Jess Tine
Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California.
Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.
Clin Gastroenterol Hepatol. 2025 Jun;23(7):1204-1215.e11. doi: 10.1016/j.cgh.2024.08.011. Epub 2024 Aug 30.
We examined the incidence and natural history of patients with very elderly onset (herein referred to as very late-onset) inflammatory bowel diseases (IBDs) (≥ 70 years of age at diagnosis), compared with patients diagnosed between 60 and 69 years of age in Denmark.
In the Danish National Patient Register, between 1980 and 2018, we identified all individuals ≥ 60 years of age with newly diagnosed Crohn's disease (CD) and ulcerative colitis (UC) and examined trends in incidence, cumulative risk of hospitalization, treatment patterns, IBD-related surgery, serious infection, cancer and cardiovascular and venous thromboembolic risks among very late-onset (70-79 years of age or 80+ years) vs late-onset (60-69 years of age) IBD, using nonparametric competing risk analysis treating death as competing risk.
We identified 3459 patients with onset of CD at ≥60 years of age (47% ≥ 70 years of age) and 10,774 patients with onset of UC ≥60 years of age (51% ≥ 70 years of age). Over the last 3 decades, incidence changes for very late-onset and late-onset IBD have followed the same patterns. Also, both for CD and UC, cumulative incidence of IBD-related hospitalization and corticosteroid use was comparable in very late-onset vs late-onset patients. However, the burden of disease-modifying therapy, either immunomodulator or tumor necrosis factor antagonist use, and major IBD-related surgery was significantly lower in patients with very late-onset than in late-onset IBD. On the other hand, the 5-year risk of serious infections and cardiovascular events was higher in patients with very late-onset IBD.
This nationwide cohort study shows that patients diagnosed with very late-onset (≥ 70 years of age) IBD have a higher relative burden of disease- and aging-related complications, with limited use of steroid-sparing strategies and surgery, compared with late-onset IBD.
我们研究了极老年发病（在此称为极晚发病）的炎症性肠病（IBD）患者（诊断时年龄≥70岁）的发病率和自然病史，并与丹麦60至69岁诊断的患者进行比较。
在丹麦国家患者登记处，1980年至2018年间，我们确定了所有年龄≥60岁新诊断为克罗恩病（CD）和溃疡性结肠炎（UC）的个体，并使用非参数竞争风险分析将死亡视为竞争风险，研究极晚发病（70 - 79岁或80岁以上）与晚发病（60 - 69岁）IBD患者在发病率、累积住院风险、治疗模式、IBD相关手术、严重感染、癌症以及心血管和静脉血栓栓塞风险方面的趋势。
我们确定了3459例60岁及以上发病的CD患者（47%年龄≥70岁）和10774例60岁及以上发病的UC患者（51%年龄≥70岁）。在过去30年中，极晚发病和晚发病IBD的发病率变化遵循相同模式。同样，对于CD和UC，极晚发病患者与晚发病患者IBD相关住院和使用皮质类固醇的累积发生率相当。然而，极晚发病患者使用改变病情疗法（免疫调节剂或肿瘤坏死因子拮抗剂）和主要IBD相关手术的负担明显低于晚发病IBD患者。另一方面，极晚发病IBD患者发生严重感染和心血管事件的5年风险更高。
这项全国性队列研究表明，与晚发病IBD相比，诊断为极晚发病（≥70岁）IBD的患者与疾病和衰老相关并发症的相对负担更高，使用类固醇节省策略和手术的情况有限。
