LAS VEGAS — The incidence of iron deficiency anemia (IDA) in hospitalized patients with inflammatory bowl disease (IBD) rose from 2002 to 2014, researchers reported here from U.S. national registry data.
Based on an analysis of data from the National Inpatient Sample (NIS), in 2002, 7.4% of patients hospitalized with symptoms of IBD were diagnosed with IDA. In 2014, that figure rose to 9.2% of hospitalized IBD patients, reported Zubair Khan, MD, of the University of Toledo Medical Center in Ohio, and colleagues.
“This analysis demonstrates the burden of IDA in patients of IBD. In a patient population with the predisposition for anemia, like patients with IBD, early diagnosis and management of iron deficiency can promptly reduce hospital visits, improve quality of life, reduce loss of work, and, ultimately, lower healthcare costs,” the authors concluded in a presentation at the Crohn’s and Colitis Congress.
“Even though we are aware that IDA often accompanies people with IBD, and we have better treatments for the disease, we still see this rise in anemia among patients hospitalized with IBD,” Khan told MedPage Today.
Khan’s group accessed the NIS database for all patients with a diagnosis of Crohn’s disease or ulcerative colitis. They identified 114,777 cases of ulcerative colitis and 154,169 cases of Crohn’s disease. Khan said 9.8% of the patients with ulcerative colitis were discharged with a diagnosis of IDA as were 7.8% of patients with Crohn’s disease.
Younger people were more likely to have IDA: 53.5% were age <50 versus 48% ages ≥50 (P<0.001).
The researchers also found that African-American IBD patients in the hospital were also more likely to be discharged with an IDA diagnosis (15.5% versus 9.3% whites, P<0.001).
IBD patients who were non-electively admitted to the hospital were also more likely to have IDA (87% versus 79.4% of patients admitted for elective procedures, P<0.001).
Determining exactly why the increase occurred was difficult because of the retrospective nature of the study, Khan stated. However, his group reported that patients at greater risk of being diagnosed with both IBD and IDA were men, Hispanic, and had comorbid conditions, particularly heart failure.
“Patients with comorbid conditions need to be managed better because of their increased risk of IDA,” Khan said. “These patients require better surveillance. This hospital discharge data show that there is something wrong in how these patients are being managed. We need to do better education of gastroenterologist so they can better manage these patients.”
Gary Lichtenstein, MD of the University of Pennsylvania in Philadelphia, told MedPage Today that IBD patients lose iron during bleeding episodes, and do not process and absorb iron as well as healthy individuals.
But the study may be showing that IBD patients who are admitted to hospitals, and have IDA, maybe just be sicker, he cautioned. These figures may speak to treatment of patients with more active disease in the hospital rather than in an out-patient setting.
“Criteria for admission to hospitals has gotten more stringent recently so we are treating more IBD patients as out-patients,” he explained. “Consequently, to get in the hospital, you are probably sicker than you were years back.”
He suggested that the increased incidence in African Americans may be due to a phenomenon of certain diseases being more prevalent in that population.
Lichtenstein noted that IBD patients, and their physicians, may not have enough information on anemia. “The [World Health Organization] definition is a hemoglobin of 12 for women and 13 for men,” he explained. “Many times, patients are seen in the office that have hemoglobins of 8 or 9 [and] who come from other practices. These patients may have major symptoms such as lethargy, low energy, cognitive impairment … IDA is not a benign condition. It has a significant impact on quality of life.”
“While our knowledge of IDA is better … access to treatment … can be lacking,” he noted. “In addition, oral iron therapy is not tolerated in up to 20% of patients who are prescribed the treatment.”
Khan disclosed no relevant relationships with industry.
Lichtenstein disclosed multiple relevant relationships with industry.
Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner