687 Epidemiology of Older-Onset Inflammatory Bowel Disease in the United States Between 2014 and 2019: A Population-Based National Study

Abstract

INTRODUCTION: Recent studies have described the rising incidence of older-onset IBD (>60 yo) in the Western world. However, the epidemiology of older-onset IBD in the United States (US) has not been studied extensively and is subject to debate. We sought to describe the prevalence and incidence of older-onset IBD in the US between 2014 and 2019 utilizing a large population based database. METHODS: We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the US from 1999 to 2019. We identified an aggregated patient cohort of eligible patients with a "first-ever" diagnosis of “Crohn's disease” or “Ulcerative Colitis” at age >60 years between June 2014 and 2019, based on Systemized Nomenclature of Medicine – Clinical Terms. We calculated the 5-year prevalence older-onset IBD overall, among different patient groups and stratified by decades. Furthermore we also calculated the incidence of older onset IBD over last 1 year between 2018 and 2019. RESULTS: Of the 10,726,480 individuals aged >60 yo active in the database from June 2014-2019, we identified 38,730 and 40,230 individuals with a diagnosis of CD and UC with an overall prevalence rate of 0.36% and 0.38% respectively. The prevalence of older-onset CD was increased in females at 0.38% [OR: 1.13, 95% CI: 1.11-1.16, P < 0.0001] compared to males at 0.34%, and Caucasians at 0.45% [OR: 1.65, 95% CI: 1.59-1.72, P < 0.0001] compared to African-Americans at 0.27%. The prevalence of older-onset UC was increased in females at 0.39% [OR: 1.07, 95% CI: 1.04-1.09, P < 0.0001] compared to males at 0.36%, and Caucasians at 0.47% [OR: 1.67, 95% CI: 1.60-1.74, P < 0.0001] compared to African-Americans at 0.28% (Figure 1). Among age-stratified analyses, as expected, the prevalence of both CD and UC was lowest in the 60-69 yo decade, increased with subsequent decades and downtrended in the 90+ age group (Figure 2). The incidence of older onset CD and UC over last 1 year between 2018 and 2019 was 0.21% and 0.20% respectively. CONCLUSION: This is one of the first large studies to date that has described the prevalence and incidence of older-onset IBD in the US. We found that the prevalence of older-onset CD and UC is higher in females and Caucasians. We further identified that older-onset CD and UC is most prevalent in the 80-89 yo decade of life and decreases thereafter.