Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2020; 26(4): 404-415
Published online Jan 28, 2020. doi: 10.3748/wjg.v26.i4.404
Trends and risk factors of elderly-onset Crohn’s disease: A nationwide cohort study
Jung Min Moon, Eun Ae Kang, Kyungdo Han, Seung Wook Hong, Hosim Soh, Seona Park, Jooyoung Lee, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim
Jung Min Moon, Eun Ae Kang, Seung Wook Hong, Hosim Soh, Seona Park, Jooyoung Lee, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim, Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
Kyungdo Han, Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Author contributions: Moon JM, Kang EA, Han K and Kim JS made the conception and designed the study; Moon JM, Kang EA, Han K, Hong SW, Soh H, Park S and Kim JS made the data acquisition, analysis and interpretation; Moon JM, Kang EA, Han K, Hong SW, Soh H and Park S drafted and revised the article; Moon JM, Kang EA, Han K, Hong SW, Soh H, Park S, Lee J, Lee HJ, Lim JP and Kim JS made the final approval of the article submitted.
Institutional review board statement: The study was approved by the Institutional Review Board of the University of Seoul National University Hospital (IRB number: H-1703-107-840).
Informed consent statement: The subjects’ information in the database was de-identified before the investigator accessed the data, thus informed consent was waived.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: Authors have read the STROBE Statement-checklist of items and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Eun Ae Kang, MD, Doctor, Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. cheerea@gmail.com
Received: November 1, 2019
Peer-review started: November 1, 2019
First decision: December 23, 2019
Revised: January 9, 2020
Accepted: January 15, 2020
Article in press: January 15, 2020
Published online: January 28, 2020
Processing time: 77 Days and 22.5 Hours
Abstract
BACKGROUND

The incidence of inflammatory bowel disease (IBD) is increasing in Asia. Numerous risk factors associated with IBD development have been investigated.

AIM

To investigate trends and environmental risk factors of Crohn’s disease (CD) diagnosed in persons aged ≥ 40 years in South Korea.

METHODS

Using the National Health Insurance Service database, a total of 14060821 persons aged > 40 years who underwent national health screening in 2009 were followed up until December 2017. Patients with newly diagnosed CD were enrolled and compared with non-CD cohort. CD was identified according to the International Classification of Diseases 10th revision and the rare/intractable disease registration program codes from the National Health Insurance Service database. The mean follow-up periods was 7.39 years. Age, sex, diabetes, hypertension, smoking, alcohol consumption, regular exercise, body mass index, anemia, chronic kidney disease (CKD) and dyslipidemia were adjusted for in the multivariate analysis model.

RESULTS

During the follow-up, 1337 (1.33/100000) patients developed CD. Men in the middle-aged group (40-64 years) had a higher risk than women [adjusted hazard ratio (aHR) 1.46, 95% confidence interval (CI): 1.29-1.66]; however, this difference tended to disappear as the age of onset increases. In the middle-aged group, patients with a history of smoking [aHR 1.46, 95%CI: 1.19-1.79) and anemia (aHR 1.85, 95%CI: 1.55-2.20) had a significantly higher CD risk. In the elderly group (age, ≥ 65 years), ex-smoking and anemia also increased the CD risk (aHR 1.68, 95%CI: 1.22-2.30) and 1.84 (95%CI: 1.47-2.30, respectively). Especially in the middle-aged group, those with CKD had a statistically elevated CD risk (aHR 1.37, 95%CI: 1.05-1.79). Alcohol consumption and higher body mass index showed negative association trend with CD incidence in both of the age groups. [Middle-aged: aHR 0.77 (95%CI: 0.66-0.89) and aHR 0.73 (95%CI: 0.63-0.84), respectively] [Elderly-group: aHR 0.57 (95%CI: 0.42-0.78) and aHR 0.84 (95%CI 0.67-1.04), respectively]. For regular physical activity and dyslipidemia, negative correlation between CD incidences was proved only in the middle-aged group [aHR 0.88 (95%CI: 0.77-0.89) and aHR 0.81 (95%CI: 0.68-0.96), respectively].

CONCLUSION

History of cigarette smoking, anemia, underweight and CKD are possible risk factors for CD in Asians aged > 40 years.

Keywords: Crohn’s disease; Aged; Environmental; Risk factors; Epidemiology; Nationwide cohort

Core tip: As the population becomes older, clinicians may encounter more cases of older-onset inflammatory bowel disease in the future. We tried to investigate trends and environmental risk factors of Crohn’s disease (CD) diagnosed in persons aged ≥ 40 years in South Korea using nationwide population-based cohort. Along with previously valued risk factors (ex-smoking, anemia and underweight), those with chronic kidney diseases were at risk of developing CD especially in the middle-aged group. Furthermore, alcohol consumption, physical activity and dyslipidemia were demonstrated to be in association with decreased incidence of late-onset Asian CDs.