Hospitalization-based major comorbidity of inflammatory bowel disease in Canada

Department of Internal Medicine, University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Canada.
Canadian journal of gastroenterology = Journal canadien de gastroenterologie (Impact Factor: 1.98). 09/2007; 21(8):507-11.
Source: PubMed


To define the patterns of hospitalization for known major comorbidities associated with inflammatory bowel disease (IBD) in Canada.
The data source was the Statistics Canada Health Person Oriented Information hospital database (1994/1995 to 2003/2004). The number of stays for a diagnosis of Crohn's disease or ulcerative colitis by the International Classification of Diseases, ninth edition, codes 555 or 556, or the International Classification of Diseases, 10th edition, Canadian Enhancement, codes K50 or K51, was extracted. Age- and sex-specific and age-adjusted rates of hospitalization for selected IBD-related comorbidities were assessed.
Rates of Hodgkin's disease and non-Hodgkin's lymphoma were low in the hospitalized IBD population. Rates for colon cancer, rectal cancer, pulmonary emboli and deep venous thromboembolism were generally higher among IBD patients younger than 50 years of age compared with the non-IBD hospitalized population.
IBD was associated with life-threatening comorbidities such as venous thromboembolic disease and colon cancer among persons younger than 50 years of age to a greater extent than the general hospitalized population. Recent secular trends in rates of non-Hodgkin's lymphomas will need to be followed to determine whether the whole population, including IBD patients who receive immunomodulating therapies, are at increased risk.

8 Reads
  • Source
    • "Numerous case reports and case series have described VTE in patients IBD [76] [77] [78] [79]. A large number of studies have confirmed that the risk of VTE is increased in patients with IBD [76] [77] [78] [79] [80] [81] [82] [83] [84] [85] [86]. One study also found increased mortality from PE in IBD patients [87]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Venous thromboembolism (VTE) is major health problem and is sometimes complicated by lethal pulmonary embolism (PE). Disturbances of the coagulation and anticoagulation systems are important risk factors for VTE. Comparative studies suggest that coagulation and innate immunity have a shared evolutionary origin. It is therefore unsurprising that the immune and coagulation systems are linked, with many molecular components being important for both systems. Systemic inflammation modulates thrombotic responses by suppressing fibrinolysis, upregulating procoagulant, and downregulating anticoagulants, and autoimmune disorders such as systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), and Behçet's syndrome have been linked to an increased risk of VTE. Recent reports have further shown that a majority of autoimmune and immune-mediated disorders are linked to an increased risk of venous thrombosis, PE, or VTE. For instance, a Swedish nationwide study found that the risk of PE was increased in the first year after hospitalization for 33 different autoimmune disorders. Especially high risks were noted for several autoimmune diseases such as immune thrombocytopenic purpura, polyarteritis nodosa, polymyositis/dermatomyositis, ulcerative colitis, and SLE. Another study from England, also based on hospitalization data, found that immune-mediated disorders were associated with an increased risk of VTE compared with other medical causes of hospitalization. Multiple mechanisms may operate and disease-specific factors, such as cardiolipin antibodies, have been identified. However, inflammation by itself appears to change the hemostatic balance in a thrombogenic direction. Recent epidemiological studies, together with previous experimental and clinical studies, indicate that autoimmune disorders should not only be viewed as inflammatory disorders, but also hypercoagulable disorders. Research to identify thrombotic risk factors, elucidate the mechanisms involved, and investigate prophylactic regiments is needed. The present review describes the epidemiological, clinical, and experimental evidence for the connection between VTE and autoimmune and immune-mediated disorders.
    American Journal of Cardiovascular Disease 08/2012; 2(3):171-83.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: RESULTS: After multivariate adjustment, both UC (OR 1.85, 95% CI 1.70-2.01) and CD discharges (OR 1.48, 95% CI 1.35-1.62) had higher rates of VTE compared to non-IBD discharges. Prevalence of VTE was greater among UC compared to CD discharges (OR 1.32, 95% CI 1.17-1.48). Among CD patients, active fistulizing disease was independently associated with greater VTE (OR 1.39, 95% CI 1.13-1.70). There was an annual 17% rise in odds of VTE among IBD admissions over 7 yr. VTE was associated with greater mortality among IBD patients (adjusted OR 2.50, 95% CI 1.83-3.43). This age- and comorbidity-adjusted excess mortality from VTE was 2.1-fold higher for IBD than for non-IBD patients (P < 0.0001). IBD patients with VTE had longer length of stay (11.7 vs 6.1 days, P < 0.0001) and incurred higher hospital charges ($47,515 vs $21,499; P < 0.0001). CONCLUSIONS: VTE is increasingly prevalent among hospitalized IBD patients and has substantial mortality and economic impact. These findings drive the need for widespread prophylaxis against and early detection of VTE among IBD inpatients. (Am J Gastroenterol 2008;103:2272-2280)
  • [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to determine if there was an increased risk for arterial thromboembolic diseases (ATED) in inflammatory bowel disease (IBD). We used the University of Manitoba IBD Epidemiology Database (1984-2003) (n = 8060), and a matched cohort (n = 80,489) drawn from the Manitoba Health administrative database. Each IBD case and non-IBD control has a unique personal health identification number and each health system encounter is identified by a diagnostic code (International Classification of Diseases, 9th revision [ICD-9]). We compared the IBD with the non-IBD cohorts for the incidence of ATED events following the index case diagnosis of IBD including: ischemic heart disease (ICD-9-Clinical Modification [CM] codes 410-414.x), cerebrovascular disease (ICD-9-CM codes 430-436.x), and undifferentiated ATED (ICD-9-CM codes 440.x and 445.x). The incidence rate of 1 episode or more of these diseases was assessed in relation to the individual person-years of follow-up evaluation. Incidence rates and incidence rate ratios (IRRs) were computed for all IBD, and stratified by IBD diagnosis, sex, and age. For ischemic heart disease, risk was increased for all IBD (IRR, 1.26; 95% confidence interval [CI], 1.11-1.44) and was increased for Crohn's disease and ulcerative colitis in both, males and females. For cerebrovascular disease, only Crohn's disease was associated with increased risk (IRR, 1.32; 95% CI, 1.05-1.66), and for undifferentiated ATED only females (IRR, 1.96; 95% CI, 1.24-3.10) and those aged 0 to 39 years (IRR, 19.95; 95% CI, 1.81-219.92) and 40 to 59 years (IRR, 3.17; 95% CI, 1.27-7.91) had significantly increased risks. IBD patients are more likely to have cardiac ATED, regardless of diagnosis or sex. Crohn's disease has an increased risk for cerebral ATED. Smoking, the prothrombotic aspect of systemic inflammation, or a genetic predisposition may contribute to the risk.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 01/2008; 6(1):41-5. DOI:10.1016/j.cgh.2007.09.016 · 7.90 Impact Factor
Show more


8 Reads
Available from