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P477. Increased risk of comorbidities associated with ulcerative colitis

T. Ali1, M. Skup2, M. Yang2, J. Chao2, P.M. Mulani2, 1University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States, 2Abbott Laboratories, Abbott Park, IL, United States

Background

Ulcerative colitis (UC) is a chronic intestinal disorder characterised by systemic inflammation. Systemic inflammation may be associated with increased risk of developing various comorbidities. We compared the risk of developing comorbidities in patients with UC to demographically matched controls without UC.

Methods

Patients aged ≥18 years with a diagnosis of UC (ICD-9: 556.xx) between 1/1/2000–12/31/2007 were selected from the Truven Health MarketScan® databases. Patients had eligibility for ≥1 year before and 2 years after the index date (defined as first UC diagnosis date). Patients with UC were matched 1:1 on sex, age, region, index date, and eligibility to controls (without UC or CD). Comorbidities of interest included anemia, nutritional disorders, anal fissures/abscesses, anal fistulas/intestinal abscesses, diabetes, hypertension, malignancy, psychiatric disorders and cardiac diseases. Patients with no comorbidity of interest for 1 year before the index date were included and followed from 6 months after the index date until the end of eligibility. Risk of developing comorbidities was examined using Kaplan–Meier curves and Cox proportional hazard models.

Results

19,495 UC patients and 19,495 controls (mean age, 48 years; 43.1% men) met inclusion criteria. A greater percentage of patients with UC vs. controls developed anemia (15% vs. 10%), nutritional disorders (0.8% vs. 0.3%), anal fissures/abscesses (1.8% vs. 0.9%), anal fistulas/intestinal abscesses (0.7% vs. 0.2%), diabetes (9.9% vs. 8.4%), hypertension (28.1% vs. 25.8%), malignancy (6.2% vs. 5%), psychiatric disorders (16.9% vs. 12.5%), and heart disease (10.3% vs. 7.8%). Cox proportional hazards model results support the increased risk of various comorbidities in patients with UC (table).

Table: Hazard rates for development of comorbidities in UC patients
ComorbidityUC patients, NaControl, NaAdjusted hazard rate (95% confidence interval)P-valueb
Anemia17,24718,7141.561 (1.471, 1.657)<0.0001
Nutritional disorder19,38819,4842.615 (1.927, 3.550)<0.0001
Anal fissure/abscess19,17019,4342.096 (1.745, 2.518)<0.0001
Anal fistula/intestinal abscess19,37519,4813.255 (2.283, 4.640)<0.0001
Diabetes17,51417,9161.204 (1.124, 1.290)<0.0001
Hypertension14,10015,1381.141 (1.092, 1.193)<0.0001
Malignancy18,34018,7921.264 (1.160, 1.378)<0.0001
Psychiatric disorder17,13817,9941.398 (1.323, 1.477)<0.0001
Congestive heart failure/ischaemic heart disease/pericarditis17,96618,5521.354 (1.264, 1.450)<0.0001
aSample size of patients without comorbidity. bP-value based on Cox proportional hazards model adjusted for age and sex.

Conclusion

After initial diagnosis, a greater percentage of UC patients developed various health-related disorders compared to controls, suggesting that UC is associated with an increased risk of these comorbid conditions.