S1174 Healthcare Utilization of Elderly Patients With Inflammatory Bowel Disease on Biologics
Bibliographic record
Abstract
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]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".