☆ 4.5 Article

Demographic and Clinical Predictors of High Healthcare Use in Patients with Inflammatory Bowel Disease

INFLAMMATORY BOWEL DISEASES (2016)

期刊

INFLAMMATORY BOWEL DISEASES

卷 22, 期 6, 页码 1442-1449

出版社

OXFORD UNIV PRESS INC

DOI: 10.1097/MIB.0000000000000763

关键词

inflammatory bowel disease; cost; depression; superuser

类别

Gastroenterology & Hepatology

资金

National Institute of Health [5T32DK063922-12]
Medical Faculty University of Crete, Greece
University of Pittsburgh Clinical and Translational Science Institute [5TL1TR000145-09]
US Army Medical Research and Material Command [W81XWH-11-2-0133]

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摘要

Background:Inflammatory bowel disease (IBD) is a heterogeneous chronic inflammatory condition requiring significant healthcare expenditure. Subgroups of individuals contribute disproportionately to spending. We aimed to determine demographic and clinical factors predictive of high healthcare expenditures for IBD patients followed over a multiyear period.Methods:This was a registry analysis using a prospective observational, consented, natural history registry from a tertiary IBD center and associated medical charges, not including pharmacy expenses. The 100 patients with the highest medical charges (top 5%) were compared with the median 300 patients. Logistic regression determined demographic and clinical factors associated with high charge patients.Results:IBD patients in the high charge group had significantly more unemployment (P < 0.0001), were of black race (P = 0.013), comorbid psychiatric illness (P = 0.002), hypertension (P = 0.01), diabetes (P = 0.004), opiate use (P < 0.0001), perianal involvement (P = 0.002), penetrating disease (P < 0.0001), and extensive colitis (P = 0.01). In multivariate analysis, unemployment (Crohn's disease [CD]: odds ratio [OR], 3.04; 95% confidence interval [CI], 1.32-7.02; ulcerative colitis [UC]: OR, 2.68; 95% CI, 1.20-5.99), psychiatric illness (UC: OR, 2.08; 95% CI, 1.03-4.19), opiates (CD: OR, 5.61; 95% CI, 2.67-11.82; UC: OR, 5.14; 95% CI, 2.52-10.48), prior surgery (CD: OR, 3.29; 95% CI, 1.59-6.82; UC: OR, 2.72; 95% CI, 1.39-5.32), penetrating CD (OR, 3.29; 95% CI, 1.02-10.62), and corticosteroid requirement (CD: OR, 3.78; 95% CI, 1.86-7.65; UC: OR, 2.98; 95% CI, 1.51-5.90) remained independently associated with high charges.Conclusions:High expenditure IBD patients were affected by more severe disease. The high prevalence of depression, anxiety, and chronic pain in these patients suggests the need for focused treatment of these comorbidities ultimately to reduce financial burden.

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Neuroinflammation as an etiological trigger for depression comorbid with inflammatory bowel disease

Colin F. Craig, Rhiannon T. Filippone, Rhian Stavely, Joel C. Bornstein, Vasso Apostolopoulos, Kulmira Nurgali

Summary: Patients with inflammatory bowel disease (IBD) have higher rates of depression, possibly due to inflammation in the central nervous system. Intestinal inflammation and dysfunction may lead to reduced intestinal permeability, allowing enterotoxins to enter the bloodstream and affect non-intestinal tissues like the brain.

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