IGH PREVALENCE OF COLORECTAL CANCER AND THE EFFECTS OF RACE AND OBESITY IN VETERANS PATIENTS DIAGNOSED WITH INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE DATABASE STUDY
TD Kou, WA Blumentals, BR Yacyshyn
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
INTRODUCTION: The etiology of inflammatory bowel disease (IBD) is complex. Indeed, risk factors can be genetic, environmental, or behavioral. The United States Veterans Administration (VA) population represents a unique patient group with its homogeneous social, demographic, and behavioral characteristics. Published studies suggested that adipocytokines play an important role in the disease pathogenesis of IBD. Chronic obesity may have an effect on the age of onset for IBD. Subsequently, IBD patients could have a higher risk for colorectal cancer (CRC). This study examined the effects of race and chronic obesity on the age of disease onset, and the prevalence of CRC in VA IBD patients.
METHODS: VA patients with ICD-9 diagnoses for Crohn's disease (CD) and ulcerative colitis (UC) were identified through the Cleveland VA Medical Center electronic record systems. The age of disease onset was the primary outcome. Demographic, weight, and clinical characteristics were collected for descriptive analyses and multivariate survival analyses. Summary data from the National Center for Health Statistics (NCHS) were used to compare prevalence data.
RESULTS: Between 1985 and 2005, 659 CD and UC patients were identified (CD: 39.2% and UC: 60.8%). 96.2% were male and 91.5% were Caucasians. The median age of onset for CD was 63.7 years and 68.7 years for UC. The incidence of chronic obesity (BMI > 30) diagnosis was higher in UC patients compared to CD patients (15.06 vs 8.56 per 10000 person-year, p = 0.04). UC patients on average had more comorbid conditions compared to CD patients (10.0 vs. 8.7, p = 0.01). African-Americans had an earlier median age of disease onset when compared to Caucasians (55.3 yrs vs 68.7 yrs). In multivariate survival analysis, chronic obese patients had earlier disease onset compared to non-obese patients when adjusted for disease type, race, and other factors. The VA IBD patients also had a much higher rate of CRC compared to the general population from NCHS data (2.9% vs. 0.1%).
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