762 Comorbidities and Opioid Use Among Patients With Crohn's Disease

Abstract

INTRODUCTION: Comorbidities associated with Crohn's disease (CD) add to the symptoms of disease and may contribute to substantial disease burden. There is a lack of information on the development of comorbidities in CD patients in the real world. This study aims to compare comorbidities, including opioid use, in CD patients relative to patients without inflammatory bowel disease (IBD), using a large database and long-term follow-up. METHODS: This was a retrospective matched cohort study. Working age adults with CD (≥2 independent claims with a CD diagnosis ≥30 days apart and within 1 year; first CD diagnosis was the index date) and controls without diagnosis for IBD (random index date) were identified in a US healthcare claims database (OptumHealth Care Solutions, Inc.) of privately-insured patients (01/1999-03/2017). CD patients were matched 1:5 with non-IBD controls using baseline characteristics, including the Quan-Charlson comorbidity index and cardiovascular disease. Comorbidities during the 12-month baseline period before the index date were reported. During the follow-up, lasting at least 12 months, the incidence of new comorbidity, including opioid use as a proxy for pain, was compared to the non-IBD controls by Kaplan-Meier (KM) rate with log-rank test. RESULTS: The study sample was composed of 6,715 CD patients and 33,575 non-IBD matched patients (average age of 45 years old, and 54% female). Pain, anemia, and fatigue were significantly higher in the CD cohort at baseline (Figure 1). Over the follow-up, new cases of cardiovascular disease were significantly higher in the CD compared to the matched non-IBD cohort with a rate of 11.5 vs 7.8%, respectively, by year 6 (Figure 2). In addition, the rates of new cases of fatigue (5.3 vs 3.2%), anemia (6.0 vs 1.9%), respiratory disease (3.5 vs 1.8%), and anxiety (5.3 vs 2.8%) were also significantly higher in the CD cohort compared to the non-IBD cohort by year 6 (log-rank P-value < 0.001). When new cases of pain diagnosis or opioid use were analyzed, the rate was significantly higher in the CD cohort, reaching 74.0% compared to 59.1% in the non-IBD cohort at year 6 (Figure 3). CONCLUSION: In this study, comorbidities, in particular new cases of pain diagnosis or opioid use, were significantly higher in CD patients relative to non-IBD patients, suggesting that the development of comorbidities may contribute to the long-term disease burden of CD.