Evidence map›Paper›PMID 27416039›Full record

ArticleInflammatory bowel diseases2016

Age Disparities in the Use of Steroid-sparing Therapy for Inflammatory Bowel Disease.

Shail M Govani, Wyndy L Wiitala, Ryan W Stidham, Sameer D Saini, Jason K Hou, Linda A Feagins, Jeremy B Sussman, Peter D R Higgins, Akbar K Waljee

Open access · bronzeAbstract readComparative Study
In one paragraph

Article in Inflammatory bowel diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed
2.7field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 37 citations in OpenAlex.

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  18. Frailty in inflammatory bowel diseases: an emerging concept.Therapeutic advances in gastroenterology · 2021
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  19. Management of Inflammatory Bowel Diseases in Special Populations: Obese, Old, or Obstetric.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Shail M Govani*Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan;†VA Ann Arbor Healthcare System, Ann Arbor, Michigan;‡VA Center for Clinical Management Research, Ann Arbor, Michigan;§Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan;‖Houston VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Department of Internal Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas; and¶Division of Gastroenterology and Hepatology, Department of Internal Medicine, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas.
Wyndy L Wiitala
Ryan W Stidham
Sameer D Saini
Jason K Hou
Linda A Feagins
Jeremy B Sussman
Peter D R Higgins
Akbar K Waljee
University of Michigan · USMichael E. DeBakey VA Medical Center · USVA Center for Clinical Management Research · USVA North Texas Health Care System · US

Funding

Application of Machine Learning Algorithms to Thiopurine Monitoring in IBDR01GM097117 · NIGMS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI HIGGINS, PETER D.R. · 2012 to 2016
$1.9M
Improving Prediction of Medical Responsiveness and Clinical Outcomes in Crohn's DiseaseK23DK101687 · NIDDK · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI STIDHAM, RYAN WILLIAM · 2015 to 2019
$945k
Patient-Centered Comparative Effectiveness of Colorectal Cancer Surveillance in IBDK08HS024122 · AHRQ · BAYLOR COLLEGE OF MEDICINE · PI HOU, JASON KEN · 2015 to 2019
$766k
Promoting Veteran-Centered Colorectal Cancer ScreeningI01HX001278 · VA · VETERANS HEALTH ADMINISTRATION · PI SAINI, SAMEER DEV · 2014 to 2014
–
Risk Stratification and Targeted Therapy for HELP Diseases in VeteransIK2HX000775 · VA · VETERANS HEALTH ADMINISTRATION · PI WALJEE, AKBAR K · 2014 to 2014
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Implementation research of benefit-based treatment for cardiovascular diseaseIK2HX001368 · VA · VETERANS HEALTH ADMINISTRATION · PI SUSSMAN, JEREMY BRODER · 2015 to 2019
–
AHRQ HHS K08 HS024122HSRD VA I01 HX001278HSRD VA IK2 HX000775HSRD VA IK2 HX001368Intramural VA VA999999NIDDK NIH HHS K23 DK101687NIGMS NIH HHS R01 GM097117
6 · The paper itself

Abstract

backgroundCorticosteroids are effective rescue therapies for patients with inflammatory bowel disease (IBD), but have significant side effects, which may be amplified in the growing population of elderly patients with IBD. We aimed to compare the use of steroids and steroid-sparing therapies (immunomodulators and biologics) and rates of complications among elderly (≥65) and younger patients in a national cohort of veterans with IBD.

methodsWe used national Veterans Health Administrative data to conduct a retrospective study of veterans with IBD between 2002 and 2010. Medications and the incidence of complications were obtained from the Veterans Health Administrative Decision Support Systems. Multivariate logistic regression accounting for facility-level clustering was used to identify predictors of use of steroid-sparing medications.

resultsWe identified 30,456 veterans with IBD. Of these, 94% were men and 40% were more than 65, and 32% were given steroids. Elderly veterans were less likely to receive steroids (23.8% versus 38.3%, P < 0.001) and were less likely to be prescribed steroid-sparing medications (25.5% versus 46.9%, respectively, P < 0.001). In multivariate analysis controlling for sex, age <65 (odds ratio, 2.19; 95% CI, 1.54-3.11) and gastroenterology care (odds ratio, 8.42; 95% CI, 6.18-11.47) were associated with initiation of steroid-sparing medications. After starting steroids, fracture rates increased in the elderly patients with IBD, whereas increases in venous thromboembolism and infections after starting steroids affected both age groups.

conclusionsElderly veterans are less likely to receive steroids and steroid-sparing medications than younger veterans; elderly patients exposed to steroids were more likely to have fractures than the younger population.

Indexed as

Adrenal Cortex HormonesAdultAgedAged, 80 and overAge FactorsBiological ProductsDrug PrescriptionsFemaleFractures, BoneGastroenterologyHumansImmunologic FactorsInflammatory Bowel DiseasesMaleMiddle AgedPractice Patterns, Physicians'Adrenal Cortex HormonesBiological ProductsImmunologic Factors

Identifiers

PMID27416039
PMCPMC4956567
OpenAlexW2468039607

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.