June 3, 2025
Do patients with elderly-onset IBD have different risks for surgery, complications, mortality?
Patients with elderly-onset IBD have general health outcomes similar to age-matched controls, but receive different IBD therapy, with reduced use of thiopurines and biologics and more abdominal surgery.
Ben Hur D, Issaschar G, Moshe R, et al. Risk of Age-related and Disease-related Complications and Mortality in Elderly-onset Inflammatory Bowel Disease – A Population-based Study. Clin Gastroenterol Hepatol. Epub ahead of print March 2025; https://doi.org/10.1016/j.cgh.2025.01.020
This nationwide population-based study from Israel examined age-related complications, mortality and disease-related outcomes in patients with elderly-onset IBD (EO-IBD), defined as diagnosis at age 65 years or older.
Using data from the Israeli IBD Research Nucleus (epi-IIRN) database, which covers 98% of the population, researchers identified 2,826 patients with EO-IBD diagnosed between 2005–2020. They compared these patients with two control groups: 6,486 age-, sex- and district-matched elderly individuals without IBD for age-related outcomes, and 11,304 adult-onset IBD patients (aged 18–65 years at diagnosis) matched by IBD subtype, sex and district for disease-related outcomes.
Of the EO-IBD cases, 52.8% had ulcerative colitis (UC) and 47.2% had Crohn’s disease (CD), with a median age at diagnosis of 71.5 years. The median follow-up was 73 months for the EO-IBD, 74 months for the elderly control comparison and 96 months for the adult-onset IBD comparison.
Patients with EO-IBD showed similar risks for age-related complications compared to elderly non-IBD controls. Mortality rates were 292.32 vs. 291.24 per 1,000 person-years (p=0.79), respectively. The adjusted hazard ratios (aHR) for EO-IBD patients showed no increased risk for pneumonia (aHR: 1.04; 95% Confidence Interval [CI], 0.84–1.29), osteoporotic fractures (aHR: 1.03; 95% CI, 0.82–1.29), bacteremia (aHR: 2.16; 95% CI, 0.87–5.40), or venous thromboembolism (aHR: 0.58; 95% CI, 0.27–1.23). The main causes of death were similar between groups, with malignancy (6.4% vs. 6%) and heart disease (3.9% vs. 4.2%) being the leading causes.
Compared to adult-onset IBD, patients with EO-IBD had significantly different treatment patterns and surgical outcomes. EO-IBD patients had lower exposure to thiopurines (aHR: 0.44; 95% CI, 0.39–0.49) and anti-tumor necrosis factor (TNF) agents (aHR: 0.37; 95% CI, 0.32–0.42). At three years from diagnosis, only 11% of EO-IBD patients used thiopurines compared to 23% of adult-onset patients, and 6.1% used anti-TNF therapy, compared to 15% of adult-onset patients. Corticosteroid use was not reduced in EO-IBD patients compared to adult-onset patients.
The risk for abdominal surgery was elevated in both EO-CD (aHR: 1.23; 95% CI, 1.04–1.46) and EO-UC (aHR: 1.51; 95% CI, 2.04–3.08), compared to adult-onset patients. Patients with EO-CD had a lower risk for perianal surgery (HR: 0.27; 95% CI, 0.16–0.47). The calculated rates of repeat perianal surgery three years after initial surgery were 7.1% in the EO-CD group versus 36% in the adult-onset CD group.
The study found that 13.9% of EO-IBD patients underwent abdominal surgery, with a median time to surgery of 17 months. Repeat abdominal surgery rates at 3 years were 29% for EO-CD compared to 21% for adult-onset CD.
Among EO-CD patients who underwent surgery, 5.8% received anti-TNF therapy at 1 year post-operatively, compared to 24% of adult-onset patients.
Details
Study Design: Population-based cohort study
Funding: Not stated
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b