Obstetrical and perinatal morbidity and mortality among in-vitro fertilization pregnancies: a population-based study.

PURPOSE: To compare patient characteristics and obstetrical/neonatal outcomes of in-vitro fertilization (IVF) and spontaneously conceived pregnancies. METHODS: Using the Nationwide Inpatient Sample, we conducted a retrospective cohort study from 2008 to 2011 comparing IVF conceptions to spontaneous ones. Patient characteristics were descriptively compared, and after adjusting for baseline characteristics with logistic regression, obstetrical/neonatal outcomes were also compared. RESULTS: Among 3,315,764 pregnancies, 5773 (0.17%) were a result of IVF. These patients were more often older, wealthier, Caucasian, non-smokers, and more likely to carry a higher order pregnancy. IVF was strongly associated with pre-eclampsia (OR 1.48, 95% CI 1.32-1.62), gestational diabetes (OR 1.27, 95% CI 1.17-1.38), antepartum hemorrhage (OR 2.04, 95% CI 1.79-2.32), placenta previa (OR 3.14, 95% CI 2.71-3.64), pre-term premature rupture of membranes (OR 1.49, 95% CI 1.30-1.70), chorioamnionitis (OR 1.52, 1.29-1.79), and cesarean section (OR 1.60, 95% CI 1.51-1.70). There was a significantly increased risk of post-partum hemorrhage (OR 2.95, 95% CI 2.29-3.80) and hysterectomy (OR 1.73, 95% CI 1.12-2.69), as well as disseminated intravascular coagulopathy (OR 2.23, 95% CI 1.24-3.99), transfusion (OR 1.78, 95% CI 1.53-2.07), prolonged hospitalization (OR 1.96, 95% CI 1.80-2.14), intrauterine growth restriction (OR 1.81, 95% CI 1.63-2.02), and pre-term birth (OR 1.31, 95% CI 1.22-1.41). CONCLUSION: IVF is still primarily used by only a subset of the population, and is associated with increased obstetrical and perinatal morbidity and mortality. These patients may benefit from more vigilant antenatal surveillance and delivery in a tertiary care center.

Maternal Risk Factors and Outcomes of Umbilical Cord Prolapse: A Population-Based Study.

OBJECTIVE: Umbilical cord prolapse (UCP) is a rare event believed to be associated with adverse outcomes. The purpose of our study was to use a large administrative database to better identify incidence, predictors, and outcomes of births with UCP. METHODS: We carried out a retrospective cohort study using data from the National Center for Health Statistics- Linked Birth Infant Death and Fetal Death (United States) data files during the years 2003-2005. The incidence, predictors, and outcomes of births with UCP were compared to births with no UCP. Logistic regression analysis was performed to estimate the adjusted effect of UCP on maternal and neonatal outcomes. RESULTS: There were 16 126 cases of UCP among 10 040 416 births, for an incidence of 16.1 cases per 10 000 births. While most cases occurred at term and in women with one or two previous births, early gestational age, grand multiparity, prolonged labour, and malpresentation were the strongest risk factors. UCP was associated with an increased risk of placental abruption, excessive bleeding, Caesarean sections, lower Apgar scores, requiring assisted ventilation, neonatal seizures, hyaline membrane disease, and fetal injuries. Deliveries by Caesarean section were associated with a greater risk of fetal injuries than vaginal delivery (18.5% vs 8.7%; OR 2.6, 95% CI 2.3 to 2.9, P < 0.001). CONCLUSION: Although there are established risk factors, UCP occurs most commonly in low risk women at term. When possible, vaginal delivery is preferred in women with UCP because it appears to be associated with a lower risk of fetal injury.

Risk of Venous Thromboembolic Events in Pregnant Patients With Autoimmune Diseases: A Population-Based Study.

OBJECTIVE: The objective of this study is to evaluate the effect of autoimmune disease on the risk of venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) in pregnant women. METHODS: Using the Health Care Cost and Utilization Project, Nationwide Inpatient Sample database from 2003 to 2011, the risk of developing DVT, PE, and VTE among pregnant patients with selected autoimmune diseases was estimated using unconditional logistic regression analysis. RESULTS: Our study cohort consisted of 7 917 453 women of which 43 523 had underlying autoimmune diseases. Risk of VTE was high in pregnant women with systemic lupus erythematosus, dermatomyositis, rheumatoid arthritis, type 1 diabetes mellitus, ulcerative colitis, and Crohn's disease. CONCLUSION: Most autoimmune diseases considerably increase the risk of VTE. Thromboprophylaxis may be considered in pregnancies with autoimmune disease, particularly those with systemic lupus erythematosus and dermatomyositis.

Pregnancy outcomes among renal transplant recipients and patients with end-stage renal disease on dialysis.

AIM: The purpose of our study is to compare pregnancy outcomes between women with a functioning renal transplant and women with end-stage renal disease (ESRD). METHODS: We carried out a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. Logistic regression analysis was used to estimate the age-adjusted effect of functioning renal transplant vs. ESRD requiring dialysis on pregnancy outcomes. RESULTS: We identified 264 birth records to women with a functional renal transplant and 267 birth records to women with ESRD on dialysis among 5,245,452 births. As compared to women with ESRD on dialysis, renal transplant recipients were less likely to have placental abruption [odds ratio, OR 0.23 (95% confidence interval, CI 0.08-0.70)], to receive blood transfusions [OR 0.17 (95% CI 0.09-0.30)], and to have growth-restricted and small-for-gestational-age babies [OR 0.45 (95% CI 0.23-0.85)]. Renal transplant recipients were more likely to have an instrumental delivery [OR 15.38 (95% CI 1.92-123.3)]. Among renal transplant women, there was a trend towards delivery by cesarean section as compared to patients with ESRD [OR 1.31 (95% CI 0.93-1.85)]. However, these results were not statistically significant. Fetal deaths were less likely to occur in women with a renal transplant [OR 0.41 (95% CI 0.17-0.96)]. There were four maternal deaths among patients with ESRD on dialysis and no maternal deaths among renal transplant patients. CONCLUSION: Patients with a functional renal graft had an overall lower rate of morbidity and adverse pregnancy complications when compared to patients with ESRD on dialysis.

Risk of venous thrombo-embolic events in pregnant patients with cancer.

OBJECTIVE: Venous thromboembolism (VTE) is one of the leading causes of pregnancy-associated death in the Western world. Cancer is a known risk factor for thrombosis outside of pregnancy. The objective of this study is to evaluate the effect of cancer on the risk of VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE) in pregnancy. METHODS: We conducted a retrospective population-based cohort study using the Health Care Cost and Utilization Project database from 2003 to 2011. Risk of developing DVT, PE and VTE among pregnant patients with the 10 most prevalent malignancies was measured using unconditional logistic regression analysis. RESULTS: A total of 2826 women were identified with underlying malignancies, among our study cohort of 7 917 453 women. Risk of VTE was increased among pregnant patients with cervical cancer (OR 8.64, 95% CI (2.15-34.79)), ovarian cancer (OR 10.35, 95% CI (1.44-74.19)), Hodgkin's disease (OR 7.87, 95% CI (2.94-21.05)) and myeloid leukemia (OR 20.75, 95% CI (6.61-65.12)). There was no increased risk of VTE among women with brain cancer, thyroid cancer, melanoma and lymphoid leukemia. CONCLUSION: Many cancers may increase risk of VTE in pregnancy. Appropriate thromboprophylaxis should be considered in some of these women, particularly those with hematological malignancies and gynecologic cancers.

Serotonin-Norepinephrine Reuptake Inhibitors and the Risk of AKI: A Cohort Study of Eight Administrative Databases and Meta-Analysis.

BACKGROUND AND OBJECTIVES: A safety signal regarding cases of AKI after exposure to serotonin-norepinephrine reuptake inhibitors (SNRIs) was identified by Health Canada. Therefore, this study assessed whether the use of SNRIs increases the risk of AKI compared with selective serotonin reuptake inhibitors (SSRIs) and examined the risk associated with each individual SNRI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Multiple retrospective population-based cohort studies were conducted within eight administrative databases from Canada, the United States, and the United Kingdom between January 1997 and March 2010. Within each cohort, a nested case-control analysis was performed to estimate incidence rate ratios (RRs) of AKI associated with SNRIs compared with SSRIs using conditional logistic regression, with adjustment for high-dimensional propensity scores. The overall effect across sites was estimated using meta-analytic methods. RESULTS: There were 38,974 cases of AKI matched to 384,034 controls. Current use of SNRIs was not associated with a higher risk of AKI compared with SSRIs (fixed-effect RR, 0.97; 95% confidence interval [95% CI], 0.94 to 1.01). Current use of venlafaxine and desvenlafaxine considered together was not associated with a higher risk of AKI (RR, 0.96; 95% CI, 0.92 to 1.00). For current use of duloxetine, there was significant heterogeneity among site-specific estimates such that a random-effects meta-analysis was performed showing a 16% higher risk, although this risk was not statistically significant (RR, 1.16; 95% CI, 0.96 to 1.40). This result is compatible with residual confounding, because there was a substantial imbalance in the prevalence of diabetes between users of duloxetine and users of others SNRIs or SSRIs. After further adjustment by including diabetes as a covariate in the model along with propensity scores, the fixed-effect RR was 1.02 (95% CI, 0.95 to 1.10). CONCLUSIONS: There is no evidence that use of SNRIs is associated with a higher risk of hospitalization for AKI compared with SSRIs.

Maternal outcomes in pregnancies affected by varicella zoster virus infections: population-based study on 7.7 million pregnancy admissions.

AIM: Previous estimates of the incidence of varicella zoster virus (VZV) pneumonia and maternal death associated with VZV infection among the pregnant population have varied considerably and been based predominantly on reports from case series. We sought to measure the incidence of VZV-related morbidity and mortality to provide more representative population estimates. METHODS: We carried out a large cohort study on all births using the United States Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database between 2003 and 2010. Descriptive statistics were used to measure baseline characteristics and outcomes of women with VZV infection. Multivariate logistic regression analyses were used to identify risk factors for the development of VZV-related morbidity and mortality. RESULTS: We identified 935 patients admitted for VZV infection among 7.7 million pregnancy admissions, representing an incidence of 1.21 cases/10 000 pregnancies (95% confidence interval [CI], 1.13-1.29). The incidence of VZV pneumonia was 2.5% (95% CI, 1.6-3.7). No maternal deaths were recorded during the 8-year study period. There were no significant risk factors identified for those who developed VZV pneumonia compared to those who had an uncomplicated VZV infection during pregnancy. CONCLUSION: The incidence of VZV pneumonia and VZV infection associated with maternal death is significantly lower than previously estimated and may reflect better immunization and earlier interventions.

Incidence and outcomes of women with Hodgkin's lymphoma in pregnancy: a population-based study on 7.9 million births.

OBJECTIVE: The purpose of our study was to estimate the incidence and maternal and fetal outcomes of Hodgkin's lymphoma (HL) in pregnancy. METHODS: We carried out a population-based cohort study on all births identified in the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. We calculated disease incidence and used logistic regression analysis to estimate the adjusted effect of HL on maternal and neonatal outcomes. RESULTS: There were 638 cases of HL in pregnancy among 7,916,388 births, for an overall incidence of 8.06 per 100,000 births, with no perceivable trend over the 8-year study period. Relative to controls, HL in pregnancy was more common among Caucasians and women aged 25-34 years. After adjusting for baseline characteristics, women with HL in pregnancy were more likely to have preterm births, odds ratio (OR) 1.93 (1.53, 2.42) require postpartum blood transfusion, OR 1.38 (1.05, 1.82), and have venous thromboembolism (VTE), OR 7.93 (2.97, 21.22). CONCLUSION: The incidence of HL in pregnancy appears to be higher than previously reported with no temporal trend over an 8-year period. Although there is a greater risk of preterm birth and maternal postpartum blood transfusion and VTE, overall maternal and neonatal major morbidity and mortality does not appear to be increased.

Incretin-based drugs and the risk of congestive heart failure.

OBJECTIVE: To determine whether the use of incretin-based drugs, including GLP-1 analogs and dipeptidyl peptidase-4 inhibitors, is associated with an increased risk of congestive heart failure (CHF) among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: The U.K. Clinical Practice Research Datalink, linked to the Hospital Episode Statistics database, was used to conduct a cohort study with a nested case-control analysis among patients newly prescribed antidiabetic drugs between 1 January 2007 and 31 March 2012 and no prior history of CHF. Case subjects were defined as patients hospitalized for a first CHF and matched with up to 20 control subjects on age, duration of treated diabetes, calendar year, and time since cohort entry. Conditional logistic regression was used to estimate odds ratios (ORs) with corresponding 95% CIs of incident CHF comparing current use of incretin-based drugs with current use of two or more oral antidiabetic drugs. RESULTS: The cohort consisted of 57,737 patients followed for a mean 2.4 years, during which time 1,118 incident cases of hospitalized CHF were identified (incidence rate 8.1/1,000 person-years). Current use of incretin-based drugs was not associated with an increased risk of CHF (adjusted OR 0.85 [95% CI 0.62-1.16]). Secondary analyses revealed no duration-response relationship (P trend = 0.39). CONCLUSIONS: In our population-based study, incretin-based drug use was not associated with an increased risk of CHF among patients with type 2 diabetes. These findings provide some reassurance, but will need to be replicated in other large-scale studies.

Incidence and outcomes of women with non-Hodgkin's lymphoma in pregnancy: a population-based study on 7.9 million births.

AIM: Non-Hodgkin's lymphoma (NHL) is a rare malignancy that can affect women of all ages. The purpose of our study was to estimate the incidence, maternal and fetal outcomes of pregnancy-associated non-Hodgkin's lymphoma (PANHL). MATERIAL AND METHODS: We conducted a population-based cohort study on all births identified in the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample from 2003 to 2011. Disease incidence was calculated and logistic regression was used to estimate the adjusted effect of NHL on maternal and fetal outcomes. RESULTS: Of 7,917,453 births, there were 427 cases of PANHL for an overall incidence of 5.39 per 100,000 births, increasing from 4.44 per 100,000 births to 7.17 per 100,000 births over the 9-year period. Relative to controls, PANHL was more common among Caucasians and women aged 25-34 years. Non-specified PANHL was most commonly coded in >81% of cases, with mycosis fungoides and Burkitt's lymphoma being the other two most common. After adjusting for baseline characteristics, women with PANHL were more likely to have pre-eclampsia, odds ratio (OR) 1.57 (95% confidence interval [CI] 1.06-2.32), cesarean section, OR 1.37 (95%CI 1.13-1.67), preterm births OR 2.50 (95%CI 1.94-3.22), postpartum blood transfusions, OR 2.73 (2.10-3.55), and infectious morbidity, OR 2.81 (95%CI 1.16-6.79). Maternal and fetal mortality rates were significantly increased among women with PANHL. CONCLUSION: The incidence of PANHL is increasing and is associated with an increased risk of maternal and neonatal morbidity and mortality, and as such, women with PANHL may best be managed in specialized centers.

Increased incidence of inflammatory bowel disease in Québec residents with airway diseases.

The objective of the study was to assess whether the incidences of Crohn's disease and ulcerative colitis are increased in patients with asthma and chronic obstructive pulmonary disease (COPD) compared to the general population. A population-based retrospective cohort study was conducted using the administrative health databases of Québec, Canada. Incidences of Crohn's disease and ulcerative colitis among patients with asthma and COPD were assessed for the 2001-2006 period. In total, 136 178 subjects with asthma and 143 904 subjects with COPD were identified. The average incidence of Crohn's disease and ulcerative colitis was 23.1 and 8.8 per 100 000 person-years among asthmatic patients; in the COPD cohort there were 26.2 Crohn's disease cases and 17 ulcerative colitis cases per 100 000 person-years. The incidence of Crohn's disease in asthma and COPD patients was 27% and 55% higher than in the general population of Québec; the incidence of ulcerative colitis was 30% higher among COPD patients compared to the general population. Incidence of inflammatory bowel disease was significantly increased in asthma and COPD patients compared to the general population of Québec. Incidence rates were particularly high in patients with COPD. Awareness of an association between airway diseases and inflammatory bowel disease in older age groups may play an important role in earlier detection of bowel disease and in the therapeutic management of such patients.

Concurrent Use of Benzodiazepines and Antidepressants and the Risk of Motor Vehicle Accident in Older Drivers: A Nested Case-Control Study.

INTRODUCTION: Aging of the population results in an increase in senior drivers. Elderly are frequently treated with benzodiazepines and antidepressants. The objective of this study was to determine whether the concurrent use of benzodiazepines and antidepressants is associated with motor vehicle accidents (MVAs) in the elderly. METHODS: This was a nested case-control study within a cohort of drivers aged 67-84 years between 1990 and 2000, identified from the Société de l'Assurance Automobile du Québec and the Régie de l'Assurance Maladie du Québec databases. First cases of MVAs during follow-up were matched with up to ten controls from the cohort. Odds ratios (ORs) for the association between MVA and the use of benzodiazepines and antidepressants were estimated using conditional logistic regression. RESULTS: The cohort included 373,818 drivers, with 74,503 MVA cases matched with 744,663 controls. The risk of MVA was higher in current users of long-acting benzodiazepines [OR 1.23; 95% confidence interval (CI) 1.16-1.29] than in current users of short-acting benzodiazepines (OR 1.05; 95% CI 1.02-1.08). The risk of MVA was increased in current users of selective serotonin reuptake inhibitors (SSRIs; OR 1.13; 95% CI 1.04-1.22), while it was not in current users of tricyclic antidepressants (TCAs; OR 1.04; 95% CI 0.96-1.14). The highest ORs of MVA were observed in long-acting benzodiazepines users concurrently using SSRIs (OR 1.37; 95% CI 1.07-1.77, P value for interaction = 0.964) or TCAs (OR 1.54; 95% CI 1.21-1.95, P value for interaction = 0.077). CONCLUSION: Use of long-acting benzodiazepines is associated with an increased risk of MVA in the elderly, particularly in those concurrently using SSRIs or TCAs.

Obstetrical and neonatal outcomes in renal transplant recipients.

OBJECTIVE: To measure the incidence and outcomes of pregnancies in renal transplant (RT) patients and to identify risk factors of adverse pregnancy outcomes. METHODS: We conducted a population-based retrospective cohort study using the United States Nationwide Inpatient Sample from 2003-2010. The incidence of pregnancies in women with RT was measured and logistic regression analysis was used to estimate the adjusted effect of RT on maternal and fetal outcomes. RESULTS: We identified 375 deliveries in patients with a RT among 7094300 births for an overall incidence of 5.3 cases per 100000 births over 8 years. Maternal complications, including preeclampsia OR=9.87 (7.76, 12.55) and blood transfusion OR=2.29 (1.69, 3.12) were more common in women with RT as compared to in women without. RT pregnancies were also complicated by an increased risk of preterm birth OR=4.65 (3.72, 5.81), intrauterine fetal death OR=3.67 (1.89, 7.15) and fetal congenital anomalies OR=5.28 (2.81, 9.90). Among women with RT and pre-existing hypertension, the risk of intrauterine growth restriction (IUGR) was considerably increased from 4.3% to 21.8%, OR=3.79 (1.67, 8.62). CONCLUSION: Pregnancies in RT patients are associated with an increased risk of maternal and fetal morbidities. Among women with RT, pre-existing hypertension strongly increases the risk of IUGR.

Pregnancy outcomes in Marfan syndrome: a retrospective cohort study.

OBJECTIVE: Marfan syndrome (MFS) is a rare connective tissue disease with significant risk for adverse cardiovascular outcomes. Our objective was to evaluate pregnancy and cardiovascular outcomes in pregnant women with MFS. STUDY DESIGN: We conducted a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS) database from 2003 to 2010. We used unconditional regression analyses to compare maternal and fetal outcomes among pregnancies in women with and without MFS. RESULTS: Out of the 7,094,400 births in our cohort, 339 deliveries were to women with MFS. There was one maternal death and six aortic dissections among women with MFS. Births to women with MFS were more likely to be premature, odds ratio (OR) 2.15 (1.60-2.89), have intrauterine growth restricted and small for gestational age infants, OR 2.06 (1.24-3.43). Women with MFS were more likely to deliver by cesarean section, OR 1.91 (1.53-2.38) and were at higher risk of major morbidities including cardiac arrhythmias, OR 10.64 (5.49-20.61) and pneumothorax, OR 51.95 (6.18, 437.10). CONCLUSION: Pregnant women with MFS are at a particularly high risk of adverse pregnancy and cardiovascular events. Preconception counseling should take these risks into consideration and appropriate pregnancy care in tertiary centers should be considered.

Sarcoidosis and pregnancy: obstetrical and neonatal outcomes in a population-based cohort of 7 million births.

OBJECTIVES: Data on sarcoidosis in pregnancy is sparse and limited to a few case reports and series. Our aim is to determine the prevalence of sarcoidosis at delivery, and related maternal and newborn outcomes. STUDY DESIGN: Using the United States Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 2003 to 2010, we conducted a population-based retrospective cohort study to compare women with and without sarcoidosis at delivery. We calculated the prevalence of sarcoidosis in pregnancy and used logistic regression analyses to estimate the associated risks of maternal and neonatal outcomes. RESULTS: There were 678 cases of sarcoidosis in 7,094,400 births over an 8-year period for an overall prevalence of nine and six-tenths cases per 100,000 births. Compared with controls, women with sarcoidosis were older, more likely to be African American and to report being smokers. Women with sarcoidosis were more likely to have preeclampsia odds ratio (OR) 1.62 (95% CI 1.18-2.22), eclampsia OR 5.27 (95% CI 1.69-16.40), deep vein thrombosis OR 4.92 (95% CI 1.58-15.33), pulmonary embolism OR 6.68 (95% CI 3.99-11.21), and premature delivery OR 1.73 (95% CI 1.40-2.15). There was also an increased risk of cesarean deliveries and postpartum hemorrhages. There were no cases of maternal death reported. CONCLUSIONS: Sarcoidosis in pregnancy is a rare disease associated with an increased risk of adverse obstetrical outcomes. Women with sarcoidosis can carry out successful pregnancies, however should be made aware of the higher risk of adverse events. Given the higher risk of venous thromboembolic events, consideration should be given to thromboprophylaxis in pregnancy.

Incidence, mortality, and sex differences of non-valvular atrial fibrillation: a population-based study.

BACKGROUND: It is unclear whether the incidence of non-valvular atrial fibrillation (NVAF) has been increasing over time. We aimed to provide contemporary estimates of the incidence and case-fatality of NVAF in a well-defined population. METHODS AND RESULTS: We used the computerized databases of the Régie de l'assurance maladie du Québec (RAMQ), responsible for administering the universal health care services for all its residents, to identify a population-based cohort of 243 800 patients with an incident diagnosis of NVAF during 2000-2009. The incidence rate of NVAF, age- and sex-standardized to the 2004 population of Québec, was 32.4 (95% confidence interval, 32.3 to 32.5) per 10 000 per year. There was no evidence of an increasing incidence of NVAF during the 10-year study period. The incidence rate was higher in men compared with women (age-adjusted incidence rate ratio 1.51; 95% CI 1.50 to 1.52). The 30-day case-fatality was 9.2% (95% CI 9.0 to 9.3), higher for men (10.0%; 95% CI 9.8 to 10.1) than women (8.5; 95% CI 8.3 to 8.6), and increasing with age, ranging from around 1% for cases aged <40 years to around 16% for cases aged ≥80. CONCLUSION: Current incidence estimates illustrate the significant burden of NVAF. Mortality remains particularly high around the time of diagnosis, and case-fatality increases with age, being systematically higher in men than women.

Oral corticosteroids and the risk of serious infections in patients with elderly-onset inflammatory bowel diseases.

OBJECTIVES: Systemic corticosteroids are among the most common anti-inflammatory treatments in elderly-onset inflammatory bowel disease (IBD) patients. Steroid use and older age each independently predisposes to infections, and infections increase mortality in hospitalized older IBD patients. Therefore, our objective was to examine the risk of serious infections in elderly-onset IBD patients treated with oral corticosteroids, and explore how the timing of exposure affects the risk estimates. METHODS: Using the health-care databases of the province of Quebec, Canada, we conducted a population-based cohort study with a nested case-control analysis. Incident IBD patients aged ≥66 years were identified. Conditional logistic regression was performed to estimate crude and adjusted rate ratios (aRRs) with 95% confidence intervals (CIs). RESULTS: We identified 3,522 elderly-onset patients, of which 564 cases with serious infections were identified during a mean 4.4 years of follow-up (incidence rate 3.7 per 100 per year) and matched to 2,646 controls. The rate of serious infections was significantly higher in those exposed to oral corticosteroids any time during the previous 6-month period compared with those nonexposed (aRR 2.3; 95% CI 1.8-2.9). Those currently exposed (within 45 days) had a higher risk (aRR 2.8; 95% CI 2.1-3.7). The residual effect of oral corticosteroids remained marginally statistically significant up to the 90-day period before the index date (aRR 1.7; 95% CI 1.0-2.7). CONCLUSIONS: We found an excess relative risk for serious infections in elderly-onset IBD patients on oral corticosteroid therapy. Those with current exposure demonstrated a higher vulnerability to infections.

Epidemiology of inflammatory bowel disease in Québec: recent trends.

BACKGROUND: Among 10 provinces in Canada, Québec has the second highest incidence of Crohn's disease (CD), based on data collected more than a decade ago. To date, there are no reports on the occurrence of ulcerative colitis (UC) and no updates on the occurrence of CD in Québec. We sought to describe trends in the annual incidence and prevalence of inflammatory bowel disease in Québec during 2001 to 2008. METHODS: A population-based retrospective cohort study was conducted using the administrative health databases of Québec. IBD cases were identified using a validated case definition requiring at least 1 hospitalization or 4 physician claims within a 2-year period. Incident cases were defined as individuals who had been free of inflammatory bowel disease for at least 2 years before the 2-year time span of the case definition. RESULTS: We identified 24,377 CD and 15,346 UC cases. The mean age at diagnosis was 39 and 46 years for CD and UC, respectively. There was a significant decline in the annual incidence from 2001 to 2008 for both CD (P < 0.003) and UC (P < 0.001). No significant change with time was found in pediatric cases. The point prevalence in 2008 was 277 CD and 164 UC cases per 100,000 population. The average incidence was 17.4 CD cases per 100,000 person-years and 10.1 UC cases per 100,000 person-years. There was no predominance of urban or rural cases for either CD or UC. CONCLUSIONS: During 2001 to 2008, annual incidence for both CD and UC declined in Québec. There was no significant change with time in incidence for pediatric cases.