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Miller SD, Cuffari C, Akhuemonkhan E, Guerrerio AL, Lehmann H, Hutfless S. Anemia Screening, Prevalence, and Treatment in Pediatric Inflammatory Bowel Disease in the United States, 2010-2014. Pediatr Gastroenterol Hepatol Nutr 2019; 22:152-161. [PMID: 30899691 PMCID: PMC6416389 DOI: 10.5223/pghn.2019.22.2.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/04/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE We examined the prevalence of anemia, annual screening for anemia, and treatment of anemia with iron among children with inflammatory bowel disease (IBD). METHODS A retrospective study of U.S. pediatric patients with IBD was performed in the MarketScan commercial claims database from 2010-2014. Children (ages 1-21) with at least two inpatient or outpatient encounters for IBD who had available lab and pharmacy data were included in the cohort. Anemia was defined using World Health Organization criteria. We used logistic regression to determine differences in screening, incident anemia, and treatment based on age at first IBD encounter and sex. RESULTS The cohort (n=2,446) included 1,560 Crohn's disease (CD) and 886 ulcerative colitis (UC). Approximately, 85% of CD and 81% of UC were screened for anemia. Among those screened, 51% with CD and 43% with UC had anemia. Only 24% of anemia patients with CD and 20% with UC were tested for iron deficiency; 85% were iron deficient. Intravenous (IV) iron was used to treat 4% of CD and 4% UC patients overall and 8% of those with anemia. CONCLUSION At least 80% of children with IBD were screened for anemia, although most did not receive follow-up tests for iron deficiency. The 43%-50% prevalence of anemia was consistent with prior studies. Under-treatment with IV iron points to a potential target for quality improvement.
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Affiliation(s)
- Steven D Miller
- Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carmelo Cuffari
- Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eboselume Akhuemonkhan
- Department of Allopathic Internal Medicine Residency, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Anthony L Guerrerio
- Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harold Lehmann
- Division of Health Science Informatics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Hutfless
- Division of Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Gastroenterology and Hepatology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Akhuemonkhan E, Parian A, Carson KA, Hutfless S. Adverse Reactions After Intravenous Iron Infusion Among Inflammatory Bowel Disease Patients in the United States, 2010-2014. Inflamm Bowel Dis 2018; 24:1801-1807. [PMID: 29669068 PMCID: PMC6241641 DOI: 10.1093/ibd/izy063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Indexed: 12/12/2022]
Abstract
Background Anemia is a frequent complication of Crohn's disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD). Intravenous (IV) iron is recommended as the initial therapy for patients with clinically active IBD, severe anemia, and intolerance to oral iron. IV iron is associated with serious adverse effects including a black box warning for anaphylaxis with iron dextran and ferumoxytol. We aimed to examine the occurrence of adverse reactions including anaphylaxis after IV iron infusions in a large database of US IBD patients. Methods We performed a retrospective analysis for encounters occurring between 2010 and 2014 in MarketScan, a US commercial claims database. We assessed the following adverse events: anaphylactic shock, bronchospasm, and hypotension among IBD patients receiving ferumoxytol, iron dextran, ferric gluconate, iron sucrose, and ferric carboxymaltose. We calculated the adverse event rate per 1000 infusions within 7 days of IV iron infusion. Results In our study cohort of 6151 IBD patients (38.4% UC), 37 168 IV iron infusions were given (median, 3 infusions). There were very few adverse events; only 1.3% of IBD patients experienced any adverse reaction. The incident rate per 1000 infusions for any adverse event among IBD patients was highest among those receiving ferumoxytol (2.54, 95% confidence interval [CI], 1.26-5.11), ferric gluconate (1.85; 95% CI, 1.03-3.35), iron sucrose (1.74; 95% CI, 1.09-2.78), and iron dextran (0.96; 95% CI, 0.43-2.13). There were 0.24 anaphylactic shock events per 1000 IV iron infusions. Conclusions About 1.3 of 100 IBD patients ever developed any adverse event. Because adverse reactions are rare, physicians should be encouraged to adhere to recommended guidelines for iron replacement among anemic IBD patients. 10.1093/ibd/izy063_video1izy063.video15768853346001.
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Affiliation(s)
- Eboselume Akhuemonkhan
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alyssa Parian
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Hutfless
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Akhuemonkhan E, Parian A, Miller K, Hanauer S, Hutfless S. Prevalence and screening for anaemia in mild to moderate Crohn's disease and ulcerative colitis in the United States, 2010-2014. BMJ Open Gastroenterol 2017; 4:e000155. [PMID: 28944071 PMCID: PMC5609082 DOI: 10.1136/bmjgast-2017-000155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/01/2017] [Accepted: 06/08/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Anaemia affects up to 74% patients with Crohn's disease (CD) and ulcerative colitis (UC) and is correlated with decreased quality of life. The European Crohn's and Colitis Organisation (ECCO) recommends at least annual screening for iron-deficiency anaemia. We aimed to determine the prevalence of anaemia, frequency of anaemia screening and factors associated with anaemia in a retrospective study of mild to moderate inflammatory bowel disease (IBD) in the USA. METHODS Adults with at least two outpatient encounters for IBD between 2010 through 2014 who contributed laboratory information were identified from MarketScan, a US commercial claims database. Hospitalised patients were considered severe and excluded from the study. WHO criteria defined anaemia. Iron-deficiency anaemia was evaluated using ferritin and C reactive protein. RESULTS The eligible population included 17 059 adults, 43.9% with CD. During the 2-year median follow-up period, 68.1% of patients with CD and 65.3% of patients with UC were screened for anaemia. The prevalence of anaemia among those screened was 32.4% in CD and 27.6% in UC. Among 669 persons with sufficient information, 79.2% of those with CD and 85.1% of those with UC had iron-deficiency anaemia. Factors associated with anaemia were similar for those with CD and UC and included ≥6 IBD-related outpatient visits, female sex, age and smoking. CONCLUSIONS More than 30% of patients with IBD in the USA were not screened for anaemia during a 2-year period. Approximately 82% of anaemic patients were iron deficient, although the absence of ferritin results limited the findings. Incorporation of screening for anaemia and, in particular, iron deficiency, should be a component of international treatment guidelines.
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Affiliation(s)
- Eboselume Akhuemonkhan
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Alyssa Parian
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | | | - Stephen Hanauer
- Division of Gastroenterology & Hepatology, Department of Medicine, Northwestern University, Chicago, USA
| | - Susan Hutfless
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
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Akhuemonkhan E, Lazo M. Association between family history of diabetes and cardiovascular disease and lifestyle risk factors in the United States population: The 2009-2012 National Health and Nutrition Examination Survey. Prev Med 2017; 96:129-134. [PMID: 28007493 DOI: 10.1016/j.ypmed.2016.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
Family history is a well-known risk factor for diabetes and cardiovascular disease (CVD) and modification of lifestyle risk factors can significantly lessen such risk. Our aim was to assess the association between family history of diabetes and/or CVD and lifestyle behaviors and risk factors (smoking, low physical activity, excessive dietary sodium and cholesterol intake and obesity) in a nationally representative sample of U.S. adults. We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2009-2012. Family history, lifestyle behaviors and risk factors were defined using self-reported and physical examination data. The study sample included 10,988 participants with a mean age of 47years. Among the U.S. adult population, 29.5%, 5.7% and 6.5% had a family history of diabetes, CVD and both diseases respectively. Compared to participants with no family history, participants with a family history of diabetes, CVD and both diabetes and CVD were more likely to be current smokers (OR=1.18[95% CI, 1.03-1.35], OR=1.68[95% CI, 1.31-2.17] and OR=1.71[95% CI, 1.30-2.26] respectively). Participants with a family history of diabetes (OR=1.42[95% CI, 1.26-1.61]) and both diabetes and CVD were more likely to be overweight/obese (OR=2.06[95% CI, 1.57-2.69]). There was no association between family history and dietary factors or physical activity. In the U.S., there is a high prevalence of modifiable risk factors among persons with a family history of diabetes and/or CVD. Healthcare providers have a significant role to play in targeting these individuals for lifestyle changes.
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Affiliation(s)
- Eboselume Akhuemonkhan
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University, MD, USA.
| | - Mariana Lazo
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, MD, USA
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Kamal A, Akhuemonkhan E, Akshintala VS, Singh VK, Kalloo AN, Hutfless SM. Effectiveness of Guideline-Recommended Cholecystectomy to Prevent Recurrent Pancreatitis. Am J Gastroenterol 2017; 112:503-510. [PMID: 28071655 DOI: 10.1038/ajg.2016.583] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Cholecystectomy during or within 4 weeks of hospitalization for acute biliary pancreatitis is recommended by guidelines. We examined adherence to the guidelines for incident mild-to-moderate acute biliary pancreatitis and the effectiveness of cholecystectomy to prevent recurrent episodes of pancreatitis. METHODS Individuals in the 2010-2013 MarketScan Commercial Claims & Encounters database with a hospitalization associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes of 577.0 for acute pancreatitis and 574.x for gallstone disease were eligible. Guideline adherence was considered cholecystectomy within 30 days of the first/index hospitalization for biliary pancreatitis. Individuals with and without guideline-adherent cholecystectomy were compared for subsequent hospitalization for acute or chronic pancreatitis using a Cox proportional hazards model adjusted for age, sex, comorbidities, and length of index hospital stay. RESULTS Of the 17,010 patients who met the inclusion criteria, 78% were adherent with the guidelines, including 10,918 who underwent cholecystectomy during the index hospitalization and 2,387 who underwent cholecystectomy within 30 days. Among 3,705 patients non-adherent with the guidelines, 1,213 had a cholecystectomy 1-6 months after the index hospitalization. Guideline-adherent cholecystectomy resulted in fewer subsequent hospitalizations for acute and chronic pancreatitis as compared with non-adherence to the guidelines (acute pancreatitis: 3% vs. 13%, P<0.001; chronic pancreatitis: 1% vs. 4%, P<0.001). CONCLUSIONS Nearly four out of five patients underwent cholecystectomy for acute biliary pancreatitis in a timeframe, consistent with guidelines. Adherence resulted in a decrease in subsequent hospitalizations for both acute and chronic pancreatitis. However, the majority of non-adherent patients did not undergo a subsequent cholecystectomy. There may be factors that predict the need for immediate vs. delayed cholecystectomy.
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Affiliation(s)
- Ayesha Kamal
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eboselume Akhuemonkhan
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Venkata S Akshintala
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vikesh K Singh
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan M Hutfless
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Wang PQ, Hu J, Al Kazzi ES, Akhuemonkhan E, Zhi M, Gao X, de Paula Pessoa RH, Ghazaleh S, Cornelius T, Sabunwala SA, Ghadermarzi S, Tripathi K, Lazarev M, Hu PJ, Hutfless S. Family history and disease outcomes in patients with Crohn’s disease: A comparison between China and the United States. World J Gastrointest Pharmacol Ther 2016; 7:556-563. [PMID: 27867689 PMCID: PMC5095575 DOI: 10.4292/wjgpt.v7.i4.556] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/05/2016] [Accepted: 09/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the differences in family history of inflammatory bowel disease (IBD) and clinical outcomes among individuals with Crohn’s disease (CD) residing in China and the United States.
METHODS We performed a survey-based cross-sectional study of participants with CD recruited from China and the United States. We compared the prevalence of IBD family history and history of ileal involvement, CD-related surgeries and IBD medications in China and the United States, adjusting for potential confounders.
RESULTS We recruited 49 participants from China and 145 from the United States. The prevalence of family history of IBD was significantly lower in China compared with the United States (China: 4.1%, United States: 39.3%). The three most commonly affected types of relatives were cousin, sibling, and parent in the United States compared with child and sibling in China. Ileal involvement (China: 63.3%, United States: 63.5%) and surgery for CD (China: 51.0%, United States: 49.7%) were nearly equivalent in the two countries.
CONCLUSION The lower prevalence of familial clustering of IBD in China may suggest that the etiology of CD is less attributed to genetic background or a family-shared environment compared with the United States. Despite the potential difference in etiology, surgery and ileal involvement were similar in the two countries. Examining the changes in family history during the continuing rise in IBD may provide further insight into the etiology of CD.
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