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Prevalence and Implications of Frailty in Older Adults With Incident Inflammatory Bowel Diseases : A Nationwide Cohort Study

Kochar, Bharati ; Jylhävä, Juulia ; Söderling, Jonas ; Ritchie, Christine S. ; Olsson, Malin ; Hjortswang, Henrik ; Myrelid, Pär ; Bengtsson, Jonas ; Strid, Hans and Andersson, Marie , et al. (2022) In Clinical Gastroenterology and Hepatology 20(10). p.11-2365
Abstract

Background and Aims: We aimed to compare the risk of frailty in older adults with incident inflammatory bowel disease (IBD) and matched non-IBD comparators and assess the association between frailty and future hospitalizations and mortality. Methods: In a cohort of patients with incident IBD ≥60 years of age from 2007 to 2016 in Sweden identified using nationwide registers, we defined frailty using Hospital Frailty Risk Score. We compared prevalence of frailty in patients with IBD with age, sex, place of residency– and calendar year–matched population comparators. In the IBD cohort, we used Cox proportional hazards modeling to examine the associations between frailty risk and hospitalizations or mortality. Results: We identified 10,590... (More)

Background and Aims: We aimed to compare the risk of frailty in older adults with incident inflammatory bowel disease (IBD) and matched non-IBD comparators and assess the association between frailty and future hospitalizations and mortality. Methods: In a cohort of patients with incident IBD ≥60 years of age from 2007 to 2016 in Sweden identified using nationwide registers, we defined frailty using Hospital Frailty Risk Score. We compared prevalence of frailty in patients with IBD with age, sex, place of residency– and calendar year–matched population comparators. In the IBD cohort, we used Cox proportional hazards modeling to examine the associations between frailty risk and hospitalizations or mortality. Results: We identified 10,590 patients with IBD, 52% female with a mean age of 71 years of age, matched to 103,398 population-based comparators. Among patients with IBD, 39% had no risk for frailty, 49% had low risk for frailty, and 12% had higher risk for frailty. Mean Hospital Frailty Risk Score was 1.9 in IBD and 0.9 in matched comparators (P < .01). Older adults with IBD at higher risk for frailty had a 20% greater risk for mortality at 3 years compared with those who were not frail. Compared with nonfrail older patients with IBD, patients at higher risk for frailty had increased mortality (hazard ratio [HR], 3.22, 95% confidence interval [CI], 2.86–3.61), all-cause hospitalization (HR, 2.42; 95% CI, 2.24–2.61), and IBD-related hospitalization (HR, 1.50; 95% CI, 1.35–1.66). These associations were not attenuated after adjusting for comorbidities. Conclusions: Frailty is more prevalent in older adults with IBD than in matched comparators. Among older patients with IBD, frailty is associated with increased risk for hospitalizations and mortality.

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publishing date
type
Contribution to journal
publication status
published
keywords
Aging, Crohn's Disease, Geriatric, Ulcerative Colitis
in
Clinical Gastroenterology and Hepatology
volume
20
issue
10
pages
11 - 2365
publisher
Elsevier
external identifiers
  • pmid:34999206
  • scopus:85126478358
ISSN
1542-3565
DOI
10.1016/j.cgh.2022.01.001
language
English
LU publication?
no
additional info
Funding Information: Funding This work was supported by grants from the Crohn’s and Colitis Foundation (Nos. 568735 [to Bharati Kochar] and 664055 [to Hamed Khalili]), National Institutes of Health (No. R03AG074059 [to Bharati Kochar]), and the Swedish Research Council (Dur 2020-02002 [to Ola Olén] and 2018-02077 [to Jonas F. Ludvigsson]). Funding Information: All data used can be requested from the Swedish National Board of Health and Welfare and Statistics after ethical approval from the Swedish Ethical Review Authority. The SWIBREG (Swedish Quality Register for Inflammatory Bowel Disease) study group consists of the following researchers: Malin Olsson,1 Henrik Hjortswang,2 P?r Myrelid,1 Jonas Bengtsson,3 Hans Strid,4 Marie Andersson,4 Susanna J?ghult,5 Michael Eberhardson,6 Caroline Nordenvall,7,8 Jan Bj?rk,9,10 Ulrika L. Fagerberg,11?13 Martin Rejler,14,15 Olof Grip,16 Pontus Karling,17 and Jonas Halfvarson.18, 1Department of Surgery, County Council of Osterg?tland, Link?ping, Sweden; 2Department of Gastroenterology and Department of Clinical and Experimental Medicine, Link?ping University, Link?ping, Sweden; 3Department of Surgery, Sahlgrenska University Hospital/?stra, Gothenburg, Sweden; 4Department of Internal Medicine, S?dra ?lvsborgs Hospital, Bor?s, Sweden; 5Stockholm Gastro Center, Karolinska Institutet, Stockholm, Sweden; 6Department of Medicine, Karolinska Institutet, Stockholm, Sweden; 7Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 8Department of Colorectal Cancer Karolinska University Hospital, Stockholm, Sweden; 9Unit of Internal Medicine, Institute Medicine Solna, Karolinska Institutet, Stockholm, Sweden; 10Patient Area Gastroenterology, Dermatovenerology and Rheumatology, Inflammation and Infection Theme Karolinska University Hospital, Stockholm, Sweden; 11Center for Clinical Research, V?stmanland Hospital, V?ster?s, Sweden and Uppsala University, Uppsala, Sweden; 12Department of Pediatrics, V?stmanland Hospital, Sweden; 13Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; 14Department of Medicine, H?glandssjukhuset Eksj?, Region J?nk?ping County Council, J?nk?ping, Sweden; 15J?nk?ping Academy for Improvement of Health and Welfare, J?nk?ping University, J?nk?ping, Sweden; 16Department of Gastroenterology, Sk?ne University Hospital, Malm?, Sweden; 17Department of Public Health and Clinical Medicine, Ume? University, Ume?, Sweden; 18Department of Gastroenterology, Faculty of Medicine and Health, ?rebro University Hospital, ?rebro, Sweden. Conflicts of interest These authors disclose the following: Bharati Kochar has served on an advisory board for Pfizer. Jonas F. Ludvigsson coordinates a study on behalf of the Swedish IBD quality register (SWIBREG), which received funding from Janssen. Hamed Khalili has received consulting fees from Takeda and AbbVie; and research support from Pfizer and Takeda. Ola Ol?n has received research funding from Janssen, Ferring Takeda, and Pfizer. The remaining authors disclose no conflicts. Funding This work was supported by grants from the Crohn's and Colitis Foundation (Nos. 568735 [to Bharati Kochar] and 664055 [to Hamed Khalili]), National Institutes of Health (No. R03AG074059 [to Bharati Kochar]), and the Swedish Research Council (Dur 2020-02002 [to Ola Ol?n] and 2018-02077 [to Jonas F. Ludvigsson]). Funding Information: Conflicts of interest These authors disclose the following: Bharati Kochar has served on an advisory board for Pfizer. Jonas F. Ludvigsson coordinates a study on behalf of the Swedish IBD quality register (SWIBREG), which received funding from Janssen. Hamed Khalili has received consulting fees from Takeda and AbbVie; and research support from Pfizer and Takeda. Ola Olén has received research funding from Janssen, Ferring Takeda, and Pfizer. The remaining authors disclose no conflicts. Publisher Copyright: © 2022 AGA Institute
id
c0a605d2-bbb9-447f-ac25-4cd9c32a3a6b
date added to LUP
2022-03-30 10:09:34
date last changed
2024-02-26 19:00:28
@article{c0a605d2-bbb9-447f-ac25-4cd9c32a3a6b,
  abstract     = {{<p>Background and Aims: We aimed to compare the risk of frailty in older adults with incident inflammatory bowel disease (IBD) and matched non-IBD comparators and assess the association between frailty and future hospitalizations and mortality. Methods: In a cohort of patients with incident IBD ≥60 years of age from 2007 to 2016 in Sweden identified using nationwide registers, we defined frailty using Hospital Frailty Risk Score. We compared prevalence of frailty in patients with IBD with age, sex, place of residency– and calendar year–matched population comparators. In the IBD cohort, we used Cox proportional hazards modeling to examine the associations between frailty risk and hospitalizations or mortality. Results: We identified 10,590 patients with IBD, 52% female with a mean age of 71 years of age, matched to 103,398 population-based comparators. Among patients with IBD, 39% had no risk for frailty, 49% had low risk for frailty, and 12% had higher risk for frailty. Mean Hospital Frailty Risk Score was 1.9 in IBD and 0.9 in matched comparators (P &lt; .01). Older adults with IBD at higher risk for frailty had a 20% greater risk for mortality at 3 years compared with those who were not frail. Compared with nonfrail older patients with IBD, patients at higher risk for frailty had increased mortality (hazard ratio [HR], 3.22, 95% confidence interval [CI], 2.86–3.61), all-cause hospitalization (HR, 2.42; 95% CI, 2.24–2.61), and IBD-related hospitalization (HR, 1.50; 95% CI, 1.35–1.66). These associations were not attenuated after adjusting for comorbidities. Conclusions: Frailty is more prevalent in older adults with IBD than in matched comparators. Among older patients with IBD, frailty is associated with increased risk for hospitalizations and mortality.</p>}},
  author       = {{Kochar, Bharati and Jylhävä, Juulia and Söderling, Jonas and Ritchie, Christine S. and Olsson, Malin and Hjortswang, Henrik and Myrelid, Pär and Bengtsson, Jonas and Strid, Hans and Andersson, Marie and Jäghult, Susanna and Eberhardson, Michael and Nordenvall, Caroline and Björk, Jan and Fagerberg, Ulrika L. and Rejler, Martin and Grip, Olof and Karling, Pontus and Halfvarson, Jonas and Ludvigsson, Jonas F. and Khalili, Hamed and Olén, Ola}},
  issn         = {{1542-3565}},
  keywords     = {{Aging; Crohn's Disease; Geriatric; Ulcerative Colitis}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{11--2365}},
  publisher    = {{Elsevier}},
  series       = {{Clinical Gastroenterology and Hepatology}},
  title        = {{Prevalence and Implications of Frailty in Older Adults With Incident Inflammatory Bowel Diseases : A Nationwide Cohort Study}},
  url          = {{http://dx.doi.org/10.1016/j.cgh.2022.01.001}},
  doi          = {{10.1016/j.cgh.2022.01.001}},
  volume       = {{20}},
  year         = {{2022}},
}