Abstract
BackgroundThe Observational Health Data Sciences and Informatics (OHDSI) network is an international collaboration established to apply open-source data analytics to a large network of health databases, including the Korean common data model (K-CDM) network.ObjectiveThe aim of this study is to analyze the effect that age at diagnosis has on the prognosis of inflammatory bowel disease (IBD) in Korea using a CDM network database.MethodsWe retrospectively analyzed the K-CDM network database from 2005 to 2015. We transformed the electronic medical record into the CDM version 5.0 used in OHDSI. A worsened IBD prognosis was defined as the initiation of therapy with biologic agents, including infliximab and adalimumab. To evaluate the effect that age at diagnosis had on the prognosis of IBD, we divided the patients into an early-onset (EO) IBD group (age at diagnosis <40 years) and a late-onset (LO) IBD group (age at diagnosis ≥40 years) with the cutoff value of age at diagnosis as 40 years, which was calculated using the Youden index method. We then used the logrank test and Cox proportional hazards model to analyze the effect that age at diagnosis (EO group vs LO group) had on the prognosis in patients with IBD.ResultsA total of 3480 patients were enrolled. There was 2017 patients with ulcerative colitis (UC) and 1463 with Crohn’s disease (CD). The median follow up period was 109.5 weeks. The EO UC group was statistically significant and showed less event-free survival (ie, experiences of biologic agents) than the LO UC group (P<.001). In CD, the EO CD group showed less event-free survival (ie, experiences of biologic agents) than the LO CD group. In the Cox proportional hazard analysis, the odds ratio (OR) of the EO UC group on experiences of biologic agents compared with the LO UC group was 2.3 (95% CI 1.3-3.8, P=.002). The OR of the EO CD group on experiences of biologic agents compared with the LO CD group was 5.4 (95% CI 1.9-14.9, P=.001).ConclusionsThe EO IBD group showed a worse prognosis than the LO IBD group in Korean patients with IBD. In addition, this study successfully verified the CDM model in gastrointestinal research.
Highlights
The EO inflammatory bowel disease (IBD) group showed a worse prognosis than the LO IBD group in Korean patients with IBD
Baars et al [14] showed that late-onset (LO) IBD is associated with the development of colorectal cancer, and Israeli et al [15] reported that early-onset (EO) IBD is associated with worse outcomes, more complex diseases, and the need for surgery
The Cox proportional hazards analysis showed that after adjustment for covariates, the odds ratio (OR) for the initiation of biologic-agent therapy in the EO ulcerative colitis (UC) group compared with the LO UC group was 2.3 (Table 4)
Summary
The incidence of inflammatory bowel disease (IBD) is increasing in newly industrialized and westernized countries [1,2,3,4,5]. Dulai et al [12] in the United States demonstrated that a history of biologic agent use, bowel surgery, fistulizing events, baseline albumin levels, and C-reactive protein levels are associated with the prognosis of Crohn's disease (CD). Khan et al [13] reported that early corticosteroid use is an independent risk factor for the prognosis of ulcerative colitis (UC). Baars et al [14] showed that late-onset (LO) IBD is associated with the development of colorectal cancer, and Israeli et al [15] reported that early-onset (EO) IBD is associated with worse outcomes, more complex diseases, and the need for surgery. The Observational Health Data Sciences and Informatics (OHDSI) network is an international collaboration established to apply open-source data analytics to a large network of health databases, including the Korean common data model (K-CDM) network
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