Incidence and Risk of Intestinal and Extra-intestinal Complications in Medicaid Patients with Inflammatory Bowel Disease: A 5-Year Population-Based Study
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Background and Aim
Intestinal and extra-intestinal complications are associated with inflammatory bowel disease (IBD) but their exact incidence is not well known. In order to improve our understanding of their incidence and impact, we assessed the complications associated with ulcerative colitis (UC) and Crohn’s disease (CD) in a population-based study in Medicaid patients.
We utilized a retrospective cohort design and identified cases of UC and CD using Medi-Cal, the Medicaid program for the State of California. The disease cohort was age- and gender-matched to four controls each and the intestinal and extra-intestinal complications of CD and UC (analyzed separately) were studied over a period of 5 years following the initial diagnosis.
For UC, the total number of intestinal complications, per 100 cases, was 92 observed compared to 21 expected; the total number of extra-intestinal complications was 42 observed compared to 30 expected. For CD, the number of intestinal complications was 81 observed compared to 20 expected and for extra-intestinal complications, 37 observed compared to 26 expected (all p < 0.001). For both UC and CD, bleeding was the most frequently seen intestinal complication, while the most common extra-intestinal complication was osteoporosis.
IBD is associated with several intestinal and extra-intestinal complications of variable incidence and risk. Success of therapeutic regimens should be measured by decreases in incidence, risks, and costs of these complications, in addition to the usual impact on disease activity.
KeywordsInflammatory bowel disease Crohn’s disease Ulcerative colitis Complications Co-morbidities
Inflammatory bowel disease
The authors have no conflicts of interest to declare. This study was sponsored by the Institute of Clinical Outcomes Research and Education (ICORE). In the past 3 years, ICORE has received grant support from Altana, Novartis, Centocor, Pfizer, and Astra-Zeneca.
- 2.National Institute of Diabetes and Digestive and Kidney Diseases. Digestive Diseases in the United States: Epidemiology and Impact. Washington, DC: US Government Printing Office. In; 1994 NIH publication 94–1447.Google Scholar
- 3.American Gastroenterological Association. The burden of gastrointestinal diseases. http://www.gastro.org/user-assets/Documents/burden-report.pdf; 1998 Accessed September 10, 2007.
- 9.Crohn’s & Colitis Foundation of America. http://www.ccfa.org; Accessed October 12, 2007.
- 10.California Department of Health Services. Medi-Cal facts and figures. www.chcf.org/documents/policy/MediCalFactsAndFigures2006.pdf; Accessed February 2, 2008.
- 11.California Department of Health Services. Medi-Cal payment error study. California Department of Health Services. http://www.dhs.ca.gov/ane/PDF/MPES%20and%20PAM%2001052005.pdf; 2004 Accessed May 17, 2007.
- 12.Parc R, Roger V, Penna C. Management of hemorrhage. In: Michelassi F, Milsom JW, eds. Operative strategies in inflammatory bowel disease. New York: Springer; 1999:229–233.Google Scholar