Age-related differences in outcomes and treatment patterns of iron deficiency anemia in patient's with crohn's disease

Abstract

Abstract Introduction Iron Deficiency Anemia (IDA) is a common extraintestinal manifestation of Crohn's Disease (CD) with reported prevalence rates ranging from 6-74%. Previous studies have shown that iron deficiency anemia is associated with increased hospitalization rates, prolonged length of stay, greater healthcare resource utilization, and detrimental effects on both quality of life and cognitive function. Additionally, a retrospective analysis by Abomhya et al. highlighted that CD patients with IDA are typically younger than those without IDA. Current literature focuses on disease burden in younger patients while the outcomes of elderly CD patients with IDA remain underexplored. Our study aims to address this gap by comparing outcomes between elderly and younger CD patients with iron deficiency anemia. Method We utilized data from the US Collaborative Network-TriNetX to examine the differences in clinical outcomes between elderly and adult patients with both CD and IDA. Patients were identified using the appropriate ICD-10 codes and stratified into two age groups: 18-64 years and 65 years and older. Both cohorts were propensity score-matched based on demographics (excluding age), therapeutics, and laboratory values to reduce potential confounding. Patients with a diagnosis of ulcerative colitis, other types of deficiency anemias, or congenital anemias were excluded from the analysis. The outcomes assessed include all-cause mortality, need for blood transfusion, requirement for parenteral iron therapy, heart failure, and emergency department (ED) visits. Results Each cohort consisted of 6654 patients after propensity score matching. After propensity score matching, 60% of the cohort was female. Our analysis showed that within a one-year period, elderly patients with CD and IDA had a significantly increased mortality rate (HR: 3.09, 95% CI: 2.59-3.69, p: <0.0001), heart failure (HR: 2.27, 95%CI: 2.02-2.54, p: <0.0001) and need for blood product transfusion (HR: 1.23, 95% CI: 1.06-1.43, p: 0.007). There was a significantly reduced rate of ED visits (HR: 0.89, 95%CI: 0.83-0.96, p 0.001) and parenteral iron administration (HR: 0.87, 95%CI: 0.77-0.93, p 0.02). Discussion Elderly patients with CD and IDA face significantly higher risks of mortality, heart failure, and need for blood transfusions compared to their younger counterparts, yet they receive parenteral iron therapy less frequently and have fewer emergency department visits. These findings underscore a clinically vulnerable population that may be both at greater risk and potentially undertreated, suggesting a gap in the management of IDA among older adults. Further research is warranted to elucidate the drivers of these disparities and to develop targeted strategies to improve outcomes in this high-risk group.