Inflammatory Bowel Disease on the Rise in Older Adults

In line with global trends, the prevalence of inflammatory bowel disease (IBD) in older U.S. adults has steadily increased over the past 2 decades, a study of Medicare beneficiaries showed.

From 2001 to 2018, the age-adjusted prevalence increased annually by 3.4% for Crohn’s disease (95% CI 3.2%-3.7%) and by 2.8% for ulcerative colitis (95% CI 2.6%-3.0%), reported Fang Xu, PhD, and colleagues from the CDC.

The largest annual percentage increase, according to the findings in Morbidity and Mortality Weekly Report, was among non-Hispanic Black individuals, at 5% for Crohn’s disease and 3.5% for ulcerative colitis, though increases were observed across all racial and ethnic groups:

• White, non-Hispanic: 3.5% for Crohn’s disease and 2.9% for ulcerative colitis
• Hispanic: 3.2% and 2.5%, respectively
• Asian/Pacific Islander: 1.7% and 1.8%
• American Indian/Alaska Native: 5.3% and 1.5%

“The potential rapid increase of disease prevalence in certain racial and ethnic minority groups indicates the need for tailored disease management strategies in these populations,” the authors wrote.

Pointing to prior research, Xu and colleagues noted that “hospitalization and mortality rates were higher among non-Hispanic Black patients than they were among non-Hispanic White patients,” and that these patients “were more likely to have severe disease activity and were less likely to maintain medical therapy for IBD or to undergo surgery.”

IBD prevalence generally increases with age, they noted, with 10% to 15% of new diagnoses in people age 60 and above, and has been rising globally. An estimated 3.7 million people worldwide had IBD in 1990, reaching 6.8 million in 2017.

For their current study, Xu’s group examined data on Medicare fee-for-services beneficiaries age 67 and older enrolled in part A and part B, omitting health maintenance plans, with yearly samples ranging from 23.7 to 25.6 million participants.

By 2018, 0.40% of the beneficiaries had received a Crohn’s disease and 0.64% had received an ulcerative colitis diagnosis, which was most common among white individuals:

• White: 0.43% for Crohn’s disease and 0.69% for ulcerative colitis
• Black: 0.26% and 0.41%, respectively
• Hispanic: 0.19% and 0.43%
• Asian/Pacific Islander: 0.15% and 0.37%
• American Indian/Alaska Native: 0.23% and 0.40%

Among the studies, other findings were that IBD was more prevalent in women than men (0.43% vs 0.36% for Crohn’s disease, respectively; and 0.68% vs 0.61% for ulcerative colitis) and that prevalence was highest in large metropolitan areas and Northeastern states.

“Living in urban areas, especially during early life, might be associated with risk for IBD through effects on the microbiome by factors such as pollution, diet, or lifestyle,” the authors explained.

Xu and colleagues cited three main limitations to the research, including that certain socioeconomic factors were inaccessible, the possibility for medical coding errors, and that the data were limited to fee-for-service beneficiaries (about two-thirds of patients on Medicare). To reduce potential medical coding errors, the research team excluded participants with both ulcerative colitis and Crohn’s disease.