Anemia affects up to 70% of pediatric Crohn's disease (CD) and ulcerative colitis (UC) patients, and is thought to be more prevalent in children than adults. Anemia is associated with disease flares and is correlated with decreased quality of life. In children with UC and CD, anemia may be associated with worse neurodevelopmental outcomes. We investigated the prevalence of anemia, anemia screening, as well as associated factors in a large population of pediatric inflammatory bowel disease (IBD) patients in the United States with a median follow up of 2.0 years between 2010 through 2014.Methods:
Patients <21 years old with at least 2 inpatient or outpatient encounters for IBD who were eligible to contribute laboratory information were identified from MarketScan, a U.S. commercial claims database. Pediatric WHO criteria were used to define anemia. We calculated screening using the proportion of the population with a hemoglobin or hematocrit test result available. Prevalence was calculated using the proportions with anemia and iron-deficiency anemia among those with a test result. Logistic regression models were used to examine factors associated with anemia and screening.Results:
The eligible population included 2449 children and adolescents including 63.7% with Crohn's disease (48.4% female) and 36.2% with ulcerative colitis (53.5% female). Mean age was 16 ± 4.1 years old. Only 75.6% of individuals were screened for anemia (77% CD; 73% UC) during the 2 year median follow-up period. The prevalence of anemia among those screened was 47% (48% CD; 43.4% UC).Conclusions:
NASPGHAN clinical guidelines suggest screening for anemia at outpatient visits. In this cohort, almost 25% of IBD patients were not screened for anemia as outpatients. Among those who were screened, about half had anemia. The limited adherence to annual anemia screening in this cohort points to the need for revised guidelines. Further work is needed to determine if lack of anemia screening leads to worsened outcomes.