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Comorbidity before and after a diagnosis of inflammatory bowel disease
Charles N Bernstein1,2, Zoann Nugent2,3, Seth Shaffer1,2
1Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Insights
Individuals with inflammatory bowel disease (IBD) face a higher burden of comorbidities. This study found increased risks for numerous conditions before and after IBD diagnosis, highlighting the need for comprehensive care.
Area of Science:
- Medical research
- Epidemiology
- Gastroenterology
Background:
- Comorbidity significantly influences the disease course of inflammatory bowel disease (IBD).
- Understanding the spectrum of comorbidities in IBD patients is crucial for effective disease management.
Purpose of the Study:
- To quantify pre-diagnosis relative rates (RR) and post-diagnosis hazard ratios (HR) of Charlson Comorbidity Index (CCI) diseases in individuals with IBD.
- To compare comorbidity prevalence in IBD patients versus a matched control group.
Main Methods:
- A population-based cohort study utilizing the University of Manitoba IBD Epidemiology Database (1984-2018).
- Analysis of outpatient physician claims and hospital discharge abstracts for CCI component diseases.
- Cox proportional hazards regression was used to calculate post-diagnosis HR, with Bonferroni correction for confidence intervals.
Main Results:
- Individuals with IBD exhibited increased RR for cardiovascular, peripheral vascular, chronic pulmonary, connective tissue/rheumatic, renal, liver, peptic ulcer, and cancer diseases prior to IBD diagnosis.
- All assessed comorbidities showed increased HR post-IBD diagnosis.
- Novel findings include increased HR for dementia in Crohn's disease patients and an unexpected association with paraplegia/hemiplegia. Comorbidities, except diabetes, were diagnosed at a younger age in IBD patients.
Conclusions:
- Individuals with IBD experience a substantially higher comorbidity burden compared to those without IBD.
- Optimal care for IBD patients necessitates proactive assessment and management of comorbidities across multiple organ systems.
Background:
Comorbidity is an important predictor of how disease course in inflammatory bowel (IBD) evolves.
Aims:
To determine pre-diagnosis relative rates (RR) and post-diagnosis hazard ratios (HR) of component diseases of the Charlson Comorbidity Index (CCI) in a cohort study of persons with IBD.
Methods:
The University of Manitoba IBD Epidemiology Database includes all Manitobans with IBD from 1 April 1984 through 31 March 2018 and matched controls. All outpatient physician claims and hospital discharge abstracts were searched for diagnostic codes for CCI component diseases. Some diseases were collapsed into one group such that we assessed 12 conditions. We report the RR of these conditions prior to IBD and the incidence of these diagnoses after IBD. Using Cox proportional hazards regression we report post-diagnosis HR. Confidence intervals were adjusted for Bonferroni correction.
Results:
The RR of cardiovascular diseases, peripheral vascular diseases, chronic pulmonary diseases, connective tissue disease/rheumatic diseases, renal disease, liver diseases, peptic ulcer disease, and cancer were all increased prior to diagnoses of IBD compared to controls. All comorbidities were increased post IBD diagnosis. The increased HR for dementia in persons with Crohn's disease was a concerning novel finding. The increased association with paraplegia/hemiplegia was unexpected. For all comorbidities, except diabetes, the age at diagnosis was younger in IBD than controls.
Conclusions:
Persons with IBD have a higher comorbidity burden than persons without IBD. Optimal care plans for persons with IBD should include an assessment for other comorbidities that include just about every other organ system.
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