Sa1291 Increased Risk of Ischemic Heart Disease Among Patients With Ulcerative Colitis: A Six Year (2004-2009) Analysis of the Nationwide Inpatient Sample

Abstract

has been advocated in certain high risk groups such as sickle cell disease, HIV/AIDS, asplenic state, bone marrow transplant, cancer chemotherapy and long term treatment with steroids. Inflammatory bowel disease (IBD) patients have an increased risk of pneumococcal pneumonias, especially when treated with immunomodulating agents. We hypothesized that IBD patients represent a group at risk for hospitalization with H. influenzae pneumonia and investigated this using the Nationwide Inpatient Sample for 2004-2009. Methods: The NIS is maintained by the Healthcare Cost and Utilization Project (HCUP) and reflects a 20% stratified sample of nonfederal, acute-care hospitals in the United States. The study group consisted of all patients with a primary diagnosis code of H. influenzae pneumonia (ICD9 482.2) and secondary diagnosis codes of crohn's disease (CD) (555.x) or ulcerative colitis (UC) (556.x). The control group consisted of patients without a primary or secondary diagnosis of CD or UC. Imputation analysis was done to estimate missing values for variables adjusted in the multivariate analysis. Multivariate logistic regression analysis was conducted using SPSS (IBM Co., Armonk, NY, USA) adjusting for age, race, gender, alcohol usage (305.0), tobacco usage (305.1)and a diabetes mellitus(250.x), additionally adjusting for primary insurance carrier, median household income, and hospital characteristics (region, bed size, rural vs. urban location, and teaching status). Results: A higher risk of hospitalization for pneumonias with H. influenzae was seen for IBD (OR 1.36, CI 1.18-1.57, higher for UC (OR 1.46, CI 1.16-1.84) than CD (OR 1.31, CI 1.09-1.58). A total of 183 hospitalizations for H. influenza pneumonia were seen over a 6 year period for IBD, at a rate of 18.7 (range 7.7-28.2) per 100,000 IBD patients per year (figure 1). The rate of hospitalizations (per 100,000 IBD patients) increased with increasing age, highest risk seen in those over 70 years of age (figure 2). Hospitalizations were associatedwithmale gender,Medicare insurance, tobacco usage and hospitals situated in Western USA, rural location, non-teaching status and small bed strength (p<0.05). Conclusion: IBD patients are at an increased risk of hospitalization with pneumonias due to H. influenzae. Routine adult vaccination with Hib in this subset of patients, in addition to other described high risk groups, may be warranted based on this study.