Epidemiology and Natural History of Elderly-onset Inflammatory Bowel Disease: Results From a Territory-wide Hong Kong IBD Registry

J Crohns Colitis. 2021 Mar 5;15(3):401-408. doi: 10.1093/ecco-jcc/jjaa181.

Abstract

Background: Elderly-onset inflammatory bowel disease [IBD], defined as age ≥60 at diagnosis, is increasing worldwide. We aimed to compare clinical characteristics and natural history of elderly-onset IBD patients with those of adult-onset IBD patients.

Methods: Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features, and outcomes of elderly-onset IBD patients were compared with those of adult-onset IBD patients.

Results: A total of 2413 patients were identified, of whom 270 [11.2%] had elderly-onset IBD. Median follow-up duration was 111 months (interquartile range [IQR]: 68-165 months). Ratio of ulcerative colitis [UC]: Crohn's disease [CD] was higher in elderly-onset IBD than in adult-onset IBD patients [3.82:1 vs 1.39:1; p <0.001]. Elderly-onset CD had less perianal involvement [5.4% vs 25.4%; p <0.001] than adult-onset CD. Elderly-onset IBD patients had significantly lower cumulative use of immunomodulators [p = 0.001] and biologics [p = 0.04]. Elderly-onset IBD was associated with higher risks of: cytomegalovirus colitis (odds ratio [OR]: 3.07; 95% confidence interval [CI] 1.92-4.89; p <0.001); herpes zoster [OR: 2.42; 95% CI 1.22-4.80; p = 0.12]; and all cancer development [hazard ratio: 2.97; 95% CI 1.84-4.79; p <0.001]. They also had increased number of overall hospitalisations [OR: 1.14; 95% CI 1.09-1.20; p <0.001], infections-related hospitalisation [OR: 1.87; 95% CI 1.47-2.38; p <0.001], and IBD-related hospitalisation [OR: 1.09; 95% CI 1.04- 1.15; p = 0.001] compared with adult-onset IBD patients.

Conclusions: Elderly-onset IBD was associated with increased risk of infections and cancer development, and increased infection- and IBD-related hospitalisations. Specific therapeutic strategies to target this special population are needed.

Keywords: Elderly-onset IBD; clinical outcomes; epidemiology.

MeSH terms

  • Age of Onset
  • Aged
  • Biological Factors / therapeutic use
  • Colitis / epidemiology
  • Colitis / virology
  • Cytomegalovirus Infections / epidemiology
  • Female
  • Herpes Zoster / epidemiology
  • Hong Kong / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Immunologic Factors / therapeutic use
  • Inflammatory Bowel Diseases / epidemiology*
  • Inflammatory Bowel Diseases / therapy
  • Male
  • Neoplasms / epidemiology
  • Opportunistic Infections / epidemiology
  • Registries

Substances

  • Biological Factors
  • Immunologic Factors