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Factors Associated with the Use of Corticosteroid-Sparing Medications among Elderly Veterans with Inflammatory Bowel Disease.
Govani SM, Wiitala WL, Stidham RW, Saini SD, Hou JK, Feagins LA, Higgins P, Waljee AK. Factors Associated with the Use of Corticosteroid-Sparing Medications among Elderly Veterans with Inflammatory Bowel Disease. Poster session presented at: Digestive Disease Week Annual Conference; 2015 May 19; Washington, DC.
Factors Associated with the Use of Corticosteroid-Sparing Medications among Elderly Veterans with Inflammatory Bowel Disease
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Presentation Number: Tu1242
Author Block: Shail M. Govani1 , Wyndy L. Wiitala2 , Ryan W. Stidham1 , Sameer D. Saini2,1 , Jason K. Hou3 , Linda A. Feagins4 , Peter Higgins1 , Akbar K. Waljee2,1
1 Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States; 2 Health Services Research and Development, Veteran's Administration, Ann Arbor, Michigan, United States; 3 Internal Medicine, Baylor College of Medicine, Houston, Texas, United States; 4 Veteran's Administration, Dallas, Texas, United States
Abstract: Background: Corticosteroids are the mainstay of rescue therapy for patients with inflammatory bowel disease (IBD) who are experiencing a disease flare. Prolonged use of corticosteroids, however, can cause a variety of complications. Early initiation of corticosteroid-sparing medications is therefore recommended. We sought to evaluate the factors associated with the use of corticosteroid-sparing medications among elderly (age 65) Veterans with IBD.
Methods: We used national Veterans Health Administrative (VHA) electronic data to conduct a retrospective cohort study of Veterans with IBD. Subjects were identified using previously validated algorithms based on a combination of inpatient and outpatient International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for Crohn's disease (CD 555.x), and ulcerative colitis (UC 556.x). Veterans were selected for inclusion if they had two or more of these ICD-9 codes during at least two clinical encounters between 2002-2009, with at least one of these encounters being an outpatient visit. We then extracted data on the use of gastroenterology (GI) specialty care and medications including the use of corticosteroids and steroid sparing medications (immunomodulators or anti-TNFs) from the VHA Decision Support Systems. Multivariate logistic regression with robust errors (to account for facility-level clustering) was used to identify predictors of use of steroid-sparing medications.
Results: We identified 9,881 Veterans with IBD who required steroids over the study period. Ninety two percent of these individuals were men, and 30% were elderly (age 65 years). Significantly fewer elderly Veterans were prescribed steroid-sparing medications when compared to non-elderly Veterans (18.4% vs 37.4%, respectively, p < 0.001). Specifically, 5.6% of elderly Veterans received anti-TNF therapy vs 21.9% of non-elderly Veterans (p < 0.001). In multivariate analysis controlling for gender, factors associated with the use of steroid sparing medications included age < 65 (OR 2.83, 95%CI: 2.02-3.96) and GI specialty care encounter prior to steroid initiation (OR 1.95, 95%CI: 1.50-2.61).
Conclusions: Elderly Veterans are less likely to receive corticosteroid-sparing medications than non-elderly Veterans. Future research should examine underlying reasons for this age-related disparity in high-quality IBD care.