The clinical practice of ulcerative colitis in elderly patients: An investigation using a nationwide database in Japan

Background and Aim: The number of elderly patients with ulcerative colitis (UC) is increasing worldwide. The clinical practice of associated treatment is still unclear. Therefore, we aimed to analyze clinical treatment realities and mortality in elderly and non-elderly patients with UC. Methods: We collected UC patients' data using the diagnosis procedure combination (DPC) database system and divided eligible patients into elderly (≥65 years) and non-elderly (≤64 years) groups. We investigated and compared their therapeutic histories (medical treatments vs. surgery). Logistic regression analysis was conducted to identify clinical factors affecting surgery and in-hospital death in each group. Results: The rates of systemic steroid injection, molecular targeting drug usage, and surgery were not different between the two age groups. Meanwhile, the rate of in-hospital death in elderly patients was higher than that in non-elderly patients (2.7% vs. 0.19%, P < 0.0001). Multivariate analysis revealed that lower body mass index, treatment at an academic hospital, smoking history, molecular targeting drug use, and treatment with systemic steroid injection affected the rate of surgery in the elderly group. Multivariate analysis also revealed that male and older age affected the rate of in-hospital death in the elderly group. Similar tendencies were also recognized in the non-elderly group. Conclusions: The clinical practice of treating elderly patients with UC is overall not different from treating non-elderly patients with UC. Although the form of medical treatment and surgery rate for elderly patients with UC may not be significantly different from non-elderly patients, the rate of in-hospital death for elderly patients is higher.