Frequency of IBD in the Elderly
Onset of IBD in the elderly population (late-onset IBD) may not be as uncommon as previously suspected. Regional differences in the incidence of IBD in the elderly have been detected. For example, the incidence of CD and UC in the US was 4/100 000/year and 6–8/100 000/year, respectively, whereas in Europe, it was 8–10/100 000/year for both UC and CD in persons aged >60 years. A population-based study indicated the incidence of CD to be 4/100 000 person-years at age 65 in 1469 European patients with CD. The annual incidence of CD in the elderly in France was 2.5/100 000. In a large cohort of 2509 patients from Sweden, the age-adjusted annual incidence was 8/100 000 person-years for UC at age 65, compared to a peak of 22/100 000 person-years at age 25. In relative terms (with respect to total IBD cases), in the largest population-based study of elderly onset IBD reported to date, 1/20 incident cases of CD and 1/8 incident cases of UC occurred in people aged >60 years. In summary, studies have shown that 10–15% of cases of IBD are diagnosed in patients aged ≥60 years.
A bimodal age curve for the incidence of IBD has been suggested in epidemiological studies, with a second peak occurring at 50–70 years. However, this proposal remains open to debate and has not been confirmed in population studies using strict radiological and endoscopic diagnostic criteria. Thus, the traditional bimodal distribution of IBD was not uniformly seen in recent epidemiological studies. Misdiagnosis leads to confusion with acute self-limiting infectious colitis, ischaemia or bowel changes associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and can therefore confound studies on the epidemiology of IBD in the elderly.
The EPIMAD Registry covers a large area of Northern France with almost 6 million inhabitants (approximately 10% of the French population). The aim of this study was to review some of the most recent data obtained from this large population-based registry since its launch in 1988. From 1988 to 2008, 18 170 incident patients were recorded in the registry. The data included 8071 cases of incident CD, 5113 cases of incident UC and 591 cases of unclassified IBD. It was concluded that the percentage of late-onset IBD patients, now estimated at 5–11%, is on the rise.
With respect to elderly patients with long-standing IBD, approximately 10–30% of the IBD population is aged >60 years. The incidence of IBD decreases with advancing age: 65% of elderly cases are aged 60–70 years, 25% are aged 70–80 years and 10% are aged >80 years.