Age Disparities in the Use of Steroid-sparing Therapy for Inflammatory Bowel Disease

Shail M. Govani, Wyndy L. Wiitala, Ryan W. Stidham, Sameer D. Saini, Jason K. Hou, Linda A. Feagins, Jeremy B. Sussman, Peter D R Higgins, Akbar K. Waljee

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Corticosteroids are effective rescue therapies for patients with inflammatory bowel disease (IBD), but have significant side effects, which may be amplified in the growing population of elderly patients with IBD. We aimed to compare the use of steroids and steroid-sparing therapies (immunomodulators and biologics) and rates of complications among elderly (≥65) and younger patients in a national cohort of veterans with IBD. Methods: We used national Veterans Health Administrative data to conduct a retrospective study of veterans with IBD between 2002 and 2010. Medications and the incidence of complications were obtained from the Veterans Health Administrative Decision Support Systems. Multivariate logistic regression accounting for facility-level clustering was used to identify predictors of use of steroid-sparing medications. Results: We identified 30,456 veterans with IBD. Of these, 94% were men and 40% were more than 65, and 32% were given steroids. Elderly veterans were less likely to receive steroids (23.8% versus 38.3%, P < 0.001) and were less likely to be prescribed steroid-sparing medications (25.5% versus 46.9%, respectively, P < 0.001). In multivariate analysis controlling for sex, age <65 (odds ratio, 2.19; 95% CI, 1.54-3.11) and gastroenterology care (odds ratio, 8.42; 95% CI, 6.18-11.47) were associated with initiation of steroid-sparing medications. After starting steroids, fracture rates increased in the elderly patients with IBD, whereas increases in venous thromboembolism and infections after starting steroids affected both age groups. Conclusions: Elderly veterans are less likely to receive steroids and steroid-sparing medications than younger veterans; elderly patients exposed to steroids were more likely to have fractures than the younger population.

Original languageEnglish (US)
Pages (from-to)1923-1928
Number of pages6
JournalInflammatory Bowel Diseases
Volume22
Issue number8
DOIs
StatePublished - May 31 2016

Fingerprint

Inflammatory Bowel Diseases
Steroids
Veterans
Therapeutics
Veterans Health
Odds Ratio
Biological Therapy
Venous Thromboembolism
Immunologic Factors
Gastroenterology
Population
Cluster Analysis
Adrenal Cortex Hormones
Multivariate Analysis
Retrospective Studies
Age Groups
Logistic Models

Keywords

  • corticosteroids
  • elderly
  • escalation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Medicine(all)
  • Gastroenterology

Cite this

Govani, S. M., Wiitala, W. L., Stidham, R. W., Saini, S. D., Hou, J. K., Feagins, L. A., ... Waljee, A. K. (2016). Age Disparities in the Use of Steroid-sparing Therapy for Inflammatory Bowel Disease. Inflammatory Bowel Diseases, 22(8), 1923-1928. https://doi.org/10.1097/MIB.0000000000000817

Age Disparities in the Use of Steroid-sparing Therapy for Inflammatory Bowel Disease. / Govani, Shail M.; Wiitala, Wyndy L.; Stidham, Ryan W.; Saini, Sameer D.; Hou, Jason K.; Feagins, Linda A.; Sussman, Jeremy B.; Higgins, Peter D R; Waljee, Akbar K.

In: Inflammatory Bowel Diseases, Vol. 22, No. 8, 31.05.2016, p. 1923-1928.

Research output: Contribution to journalArticle

Govani, SM, Wiitala, WL, Stidham, RW, Saini, SD, Hou, JK, Feagins, LA, Sussman, JB, Higgins, PDR & Waljee, AK 2016, 'Age Disparities in the Use of Steroid-sparing Therapy for Inflammatory Bowel Disease', Inflammatory Bowel Diseases, vol. 22, no. 8, pp. 1923-1928. https://doi.org/10.1097/MIB.0000000000000817
Govani SM, Wiitala WL, Stidham RW, Saini SD, Hou JK, Feagins LA et al. Age Disparities in the Use of Steroid-sparing Therapy for Inflammatory Bowel Disease. Inflammatory Bowel Diseases. 2016 May 31;22(8):1923-1928. https://doi.org/10.1097/MIB.0000000000000817
Govani, Shail M. ; Wiitala, Wyndy L. ; Stidham, Ryan W. ; Saini, Sameer D. ; Hou, Jason K. ; Feagins, Linda A. ; Sussman, Jeremy B. ; Higgins, Peter D R ; Waljee, Akbar K. / Age Disparities in the Use of Steroid-sparing Therapy for Inflammatory Bowel Disease. In: Inflammatory Bowel Diseases. 2016 ; Vol. 22, No. 8. pp. 1923-1928.
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abstract = "Background: Corticosteroids are effective rescue therapies for patients with inflammatory bowel disease (IBD), but have significant side effects, which may be amplified in the growing population of elderly patients with IBD. We aimed to compare the use of steroids and steroid-sparing therapies (immunomodulators and biologics) and rates of complications among elderly (≥65) and younger patients in a national cohort of veterans with IBD. Methods: We used national Veterans Health Administrative data to conduct a retrospective study of veterans with IBD between 2002 and 2010. Medications and the incidence of complications were obtained from the Veterans Health Administrative Decision Support Systems. Multivariate logistic regression accounting for facility-level clustering was used to identify predictors of use of steroid-sparing medications. Results: We identified 30,456 veterans with IBD. Of these, 94{\%} were men and 40{\%} were more than 65, and 32{\%} were given steroids. Elderly veterans were less likely to receive steroids (23.8{\%} versus 38.3{\%}, P < 0.001) and were less likely to be prescribed steroid-sparing medications (25.5{\%} versus 46.9{\%}, respectively, P < 0.001). In multivariate analysis controlling for sex, age <65 (odds ratio, 2.19; 95{\%} CI, 1.54-3.11) and gastroenterology care (odds ratio, 8.42; 95{\%} CI, 6.18-11.47) were associated with initiation of steroid-sparing medications. After starting steroids, fracture rates increased in the elderly patients with IBD, whereas increases in venous thromboembolism and infections after starting steroids affected both age groups. Conclusions: Elderly veterans are less likely to receive steroids and steroid-sparing medications than younger veterans; elderly patients exposed to steroids were more likely to have fractures than the younger population.",
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AU - Hou, Jason K.

AU - Feagins, Linda A.

AU - Sussman, Jeremy B.

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N2 - Background: Corticosteroids are effective rescue therapies for patients with inflammatory bowel disease (IBD), but have significant side effects, which may be amplified in the growing population of elderly patients with IBD. We aimed to compare the use of steroids and steroid-sparing therapies (immunomodulators and biologics) and rates of complications among elderly (≥65) and younger patients in a national cohort of veterans with IBD. Methods: We used national Veterans Health Administrative data to conduct a retrospective study of veterans with IBD between 2002 and 2010. Medications and the incidence of complications were obtained from the Veterans Health Administrative Decision Support Systems. Multivariate logistic regression accounting for facility-level clustering was used to identify predictors of use of steroid-sparing medications. Results: We identified 30,456 veterans with IBD. Of these, 94% were men and 40% were more than 65, and 32% were given steroids. Elderly veterans were less likely to receive steroids (23.8% versus 38.3%, P < 0.001) and were less likely to be prescribed steroid-sparing medications (25.5% versus 46.9%, respectively, P < 0.001). In multivariate analysis controlling for sex, age <65 (odds ratio, 2.19; 95% CI, 1.54-3.11) and gastroenterology care (odds ratio, 8.42; 95% CI, 6.18-11.47) were associated with initiation of steroid-sparing medications. After starting steroids, fracture rates increased in the elderly patients with IBD, whereas increases in venous thromboembolism and infections after starting steroids affected both age groups. Conclusions: Elderly veterans are less likely to receive steroids and steroid-sparing medications than younger veterans; elderly patients exposed to steroids were more likely to have fractures than the younger population.

AB - Background: Corticosteroids are effective rescue therapies for patients with inflammatory bowel disease (IBD), but have significant side effects, which may be amplified in the growing population of elderly patients with IBD. We aimed to compare the use of steroids and steroid-sparing therapies (immunomodulators and biologics) and rates of complications among elderly (≥65) and younger patients in a national cohort of veterans with IBD. Methods: We used national Veterans Health Administrative data to conduct a retrospective study of veterans with IBD between 2002 and 2010. Medications and the incidence of complications were obtained from the Veterans Health Administrative Decision Support Systems. Multivariate logistic regression accounting for facility-level clustering was used to identify predictors of use of steroid-sparing medications. Results: We identified 30,456 veterans with IBD. Of these, 94% were men and 40% were more than 65, and 32% were given steroids. Elderly veterans were less likely to receive steroids (23.8% versus 38.3%, P < 0.001) and were less likely to be prescribed steroid-sparing medications (25.5% versus 46.9%, respectively, P < 0.001). In multivariate analysis controlling for sex, age <65 (odds ratio, 2.19; 95% CI, 1.54-3.11) and gastroenterology care (odds ratio, 8.42; 95% CI, 6.18-11.47) were associated with initiation of steroid-sparing medications. After starting steroids, fracture rates increased in the elderly patients with IBD, whereas increases in venous thromboembolism and infections after starting steroids affected both age groups. Conclusions: Elderly veterans are less likely to receive steroids and steroid-sparing medications than younger veterans; elderly patients exposed to steroids were more likely to have fractures than the younger population.

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