S1174 Healthcare Utilization of Elderly Patients With Inflammatory Bowel Disease on Biologics
Notice bibliographique
Résumé
Introduction: The incidence of inflammatory bowel disease (IBD) in the elderly is increasing as our population ages. The elderly population tends to suffer a more severe initial flare, though biologics are less often used in the elderly due to poorer response rates and more side effects1. Introducing biologics soon after initial diagnosis improves efficacy, yet the elderly are often excluded from randomized control trials for biologics, highlighting the need for more data in this vulnerable population. Our aims were to characterize biologic use for IBD in the elderly population (age >65) and assess healthcare utilization for elderly patients after starting biologics. Methods: Retrospective cohort study of IBD patients based on ICD9-10 codes, diagnosed between 12/15/10-7/1/17 with >1 year of follow-up using the Indiana Network for Patient Care research database. Age groups were created to evaluate trends in biologic use and outcome by age. Logistic regression was used to calculate odds ratios for ED visits, hospitalizations, IBD surgeries, steroids, and opioids for the year following initiation of biologic therapy. Results: 10,627 subjects were included. 55.4% were female, 89.7% were White, and 54.2% had Ulcerative Colitis. 1,606 were prescribed biologics with lower rates in the elderly (6.1% vs. 19.2%; P< 0.001). In logistic regression models, individuals age >65 had a significantly lower odds of having ED visits compared to those less than age 65 (OR 0.44 95% CI [0.19-0.87]; P=0.03) (Table 1). Hospital visits, IBD surgeries, steroid orders, and opioid orders did not significantly differ between ages >65 and < 65. Conclusion: Among those on biologics, those age >65 had lower odds of ED visits without significant differences in other healthcare utilization for the year following initiation of a biologic. These findings provide reassurance for the use of biologic therapy in elderly patients with IBD. References: 1. Juneja M, Baidoo L, Schwartz MB, Barrie A, 3rd, Regueiro M, Dunn M, et al. Geriatric inflammatory bowel disease: phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity. Dig Dis Sci. 2012;57(9):2408-15. Table 1. - Demographics and healthcare utilization outcomes of participants grouped by age<65 and 65+ Age < 65 (n=8369) Age ≥65 (n=2258) Total (n=10627) Female, n (%) 4633 (55.4%) 1252 (55.4%) 5885 (55.4%) Race, n (%) Black 652 (7.8%) 91 (4.0%) 743 (7.0%) White 7413 (88.6) 2119 (93.8%) 9532 (89.7%) Other 304 (3.6%) 48 (2.1%) 352 (3.3%) IBD Type, n (%) Ulcerative Colitis 2708 (32.4%) 1083 (48.0%) 3791 (35.7%) Crohn’s Disease 4732 (56.5%) 1023 (45.3%) 5755 (54.2%) IBD-Unclassified 929 (11.1%) 152 (6.7%) 1081 (10.2%) Immunomodulator, n (%) 1455 (17.4%) 294 (13.0%) 1749 (16.5%) BMI >30, n (%) 2920 (34.9%) 811 (35.9%) 3731 (35.1%) Smoking Status, n (%) Never 3675 (43.9%) 803 (35.6%) 4478 (42.1%) Former 850 (10.1%) 539 (23.9%) 1389 (13.1%) Current 1345 (16.1%) 158 (7.0%) 1503 (14.1%) Unknown 3257 (38.9%) 758 (33.6%) 3257 (30.6%) Prior ED Visit, n (%) 658 (7.9%) 132 (5.8%) 790 (7.4%) Prior Hospitalization, n (%) 530 (6.3%) 162 (7.2%) 692 (6.5%) Prior IBD Surgery, n (%) 179 (2.1%) 36 (1.6%) 215 (2.0%) Prior Steroids, n (%) 303 (3.6%) 58 (2.6%) 361 (3.4%) Prior Opioids, n (%) 568 (6.8%) 135 (6.0%) 703 (6.6%) ED Visit, OR [95% CI] (Age ≥65 vs < 65) -- -- 0.44 [0.19-0.87] Hospitalization, OR [95% CI] (Age ≥65 vs < 65) -- -- 1.35 [0.92-1.96] IBD Surgery, OR [95% CI] (Age ≥65 vs < 65) -- -- 1.17 [0.64-2.00] Steroids, OR [95% CI] (Age ≥65 vs < 65) -- -- 0.91 [0.59-1.37] Opioids, OR [95% CI] (Age ≥65 vs < 65) -- -- 0.73 [0.47-1.10]
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».