As the American population is aging, the number of people with a new diagnosis of IBD at an older age and the number of people who age with IBD is increasing. We used clinical data from the Sinai-Helmsley Alliance for Research Excellence (SHARE), a prospective cohort, to examine disease and treatment differences in older adults.Methods:
We performed a cross-sectional study of participants at study entry assessing demographics and disease behavior by age at diagnosis with univariate, bivariate and multivariate analyses. “Older-onset” patients were diagnosed after age 60, “younger-onset” patients were diagnosed before age 60, but are now older than 60 years. The remainder were “young”.Results:
There were 91 older-onset, 389 younger-onset and 3431 young Crohn's disease (CD) patients. Mean ages were 70 years for the older-onset group, 66 years for the younger-onset group and 37 years for the young group. Older-onset patients had more ileal (37%) and colonic (27%) disease compared to younger-onset and young patients (P < 0.01). After controlling for confounders, there were no differences in disease behavior, location or surgeries between older-onset and young CD patients within 5 years of diagnosis. Newly diagnosed older-onset patients with inflammatory disease behavior had a higher odds of being in remission, by Harvey-Bradshaw Index (HBI) compared to newly diagnosed young CD patients (87% versus 68%, P = 0.03). Young CD patients reported more anti-TNF and thiopurine use compared to younger-onset and older-onset patients (P < 0.01). There were no differences in corticosteroid use between young, younger-onset and older-onset CD patients. There were 98 late-onset, 218 younger-onset and 1702 young ulcerative colitis (UC) patients. Mean ages were the same as CD patients for all 3 groups. There were no differences in disease extent or Simple Clinical Colitis Activity Index (SCCAI) scores. After adjusting for disease duration and remission status, older-onset UC patients had 0.22 times the odds of having surgery compared to younger-onset patients (95% confidence interval: 0.06–0.83). Young UC patients reported more anti-TNF use (26%) compared to younger-onset patients (17%, P < 0.01). Older onset patients reported more anti-integrin use (5%) compared to younger-onset (1%) and young (1%) UC patients (P < 0.01). There was no difference in corticosteroid use between the 3 groups. When comparing older-onset UC patients within 5 years of diagnosis to young UC patients within 5 years of diagnosis, there were no differences in disease extent, SCCAI scores, remission status and surgical status.Conclusions:
Disease behavior or location were not different between young adults and adults with older-onset IBD as the literature currently suggests. Older patients were less likely to be treated with immunosuppression. As older patients may not have different disease, less frequent treatment with immunosuppressives may risk sub-optimally controlled disease.