title: Risk of Surgery and Mortality in Elderly-onset Inflammatory Bowel Disease: A Population-based Cohort Study.
abstract: As the prevalence of inflammatory bowel disease (IBD) increases in the elderly population, we sought to characterize IBD-related outcomes in this population.
  
  
  
  We identified incident IBD cases in Ontario, Canada between 1999 and 2008 and categorized subjects by age at diagnosis as young adults (18-40 yr); middle-age adults (41-64 yr); and elderly (≥65 yr) from within population-based health administrative data. We determined the risk of IBD-related surgery and mortality in those with elderly-onset IBD compared with other age groups.
  
  
  
  Of 21,218 persons with IBD, there were 1749 cases of elderly-onset ulcerative colitis (UC) and 725 cases elderly-onset Crohn's disease (CD). Elderly UC had higher rates of IBD-related surgery than those with young-adult UC (adjusted hazard ratio, 1.34; 95% CI, 1.16-1.55), although there was no difference in surgical rates between age groups in CD. IBD-specific mortality was higher in elderly-onset CD (33.1/10,000 person-year) compared with that in middle-age CD (5.6/10,000 person-year, P < 0.0001) and young adult CD (1.0/10,000 person-year) but was not different by age in UC. The leading cause of death in elderly UC and CD was solid malignancies accounting for 22.9% and 26.4% of deaths, respectively, whereas IBD was third most frequent cause of death accounting for 6.3% and 9.1% of deaths, respectively.
  
  
  
  Elderly-onset patients with UC were more likely to undergo surgery while elderly-onset patients with CD exhibited higher IBD-specific mortality than those with younger-onset disease. These findings should prompt more optimized disease management in elderly IBD.
authors.affiliation: *Department of Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Ontario, Canada; †Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; ‡Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada; §University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre and ‖Department of Internal Medicine, Winnipeg, Canada; and ¶Children's Hospital of Eastern Ontario IBD Centre, Department of Pediatrics, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
authors.forename: Eric I
authors.initials: EI
authors.lastname: Benchimol
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000401:mortality* / Q000601:surgery; D003424:Crohn Disease / Q000401:mortality* / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult