Inflammatory bowel disease and risk of cancer: A nationwide study.

Abstract

e15663 Background: Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic inflammatory condition of the gastrointestinal tract. Existing research suggests that chronic inflammation, immune dysregulation, and prolonged use of immunosuppressive therapy may contribute to increased cancer risk in IBD. However, nationwide data on the prevalence and types of cancer in U.S. IBD patients remain limited. This study aimed to determine the frequency and associations of various cancers among individuals with IBD. Methods: We conducted a retrospective cross-sectional study using the 2016–2018 Nationwide Inpatient Sample (NIS), encompassing adult hospitalizations in the U.S. The NIS approximates 20% of hospital discharges nationwide. Patients with IBD were identified via ICD-10-CM codes. Statistical analyses were performed with SAS 9.4. We used chi-square tests for univariate analysis and multivariate logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI). Statistical significance was set at p < 0.05. Results: Out of 87,761,798 U.S. hospitalizations, 0.67% involved CD and 0.39% involved UC. Prevalence of pancreatic cancer was 0.16% in CD and 0.22% in UC. Melanoma skin cancer prevalence was 0.07%, while non-melanoma skin cancers (NMSC)—including squamous cell, basal cell, and Merkel cell carcinomas—were observed at 0.03% (p < 0.0001). Notably, melanoma was more frequent in UC (0.13%) compared to CD (0.07%) or non-IBD (0.07%). Colon cancer occurred in 0.05% of IBD patients. Leukemia was documented in 0.51% of CD and 0.61% of UC hospitalizations. Barrett’s esophagus (BE) without dysplasia was seen in 0.76%, and BE with dysplasia in 0.01%. Esophageal malignancy prevalence was 0.03% in CD and 0.08% in UC. Multivariate regression indicated that UC was associated with a 51% higher melanoma risk than CD (aOR: 1.51, 95%CI: 1.22–1.85). BE risk was significantly elevated in CD (aOR: 1.67, 95%CI: 1.55–1.79) and UC (aOR: 1.77, 95%CI: 1.62–1.93). Age over 75 significantly increased cancer risk (aOR: 1.99, 95%CI: 1.58–2.51). Additionally, Black patients (aOR: 1.20, 95%CI: 1.17–1.24) and smokers (aOR: 1.39, 95%CI: 1.20–1.61) showed higher odds of cancer. Conclusions: These findings highlight the need for vigilant, long-term surveillance of IBD patients to reduce gastrointestinal and melanoma cancer risks. Higher risk in specific demographics suggests the importance of tailored screening protocols. Further research on the potential for hematological malignancies in IBD is warranted to enhance understanding and improve patient care.