Classification of Long-term Disease Patterns in Inflammatory Bowel Disease and Analysis of their Associations with Adverse Health Events: a UK Biobank Cohort Study

Abstract

Abstract Background With existing researches identifying an increased risk of long-term conditions (LTCs) among Inflammatory Bowel Disease (IBD) patients, yet there is a lack of exploration into the patterns of comorbidity and prognostic risks for IBD patients with multiple morbidities. Methods We included 8,305 participants who self-reported having IBD (comprising UC and CD) and utilized latent class analysis (LCA) to create optimal categories of LTC combinations for UC and CD patients with additional LTCs. Using Cox proportional hazards models, we compared the all-cause mortality risk over a 16-year follow-up among UC and CD patients within different LTC categories, both without LTCs and with the addition of one LTC, risks of major adverse cardiovascular events (MACE), and the risk of IBD-related surgeries. Results A total of 5,617 participants reported having two or more LTCs, with the LCA method identifying three prevalence categories among CD patients, and four prevalence categories among UC patients. The highest mortality rate among CD patients was found in category 3: (HR 1.789, 95% CI (1.439–2.224)), and the highest risk of MACE was also in category 3: (HR 11.432, 95% CI (9.332–14.005)), with hypertension being the distinguishing characteristic of this category, and the highest rate of IBD-related surgeries being associated with pain in category 1: (HR 1.217, 95% CI (0.983–1.506)). Among UC patients, the highest mortality rate was in category 3: (HR 2.221, 95% CI (1.837–2.684)), with the highest MACE risk found in category 3: (HR 6.422, 95% CI (5.659–7.288)), and the highest rate of IBD-related surgeries being associated with pain, also in category 3: (HR 1.218, 95% CI (1.041–1.425)). Conclusion The risk of adverse health outcomes in IBD patients is closely associated with multimorbidity patterns, underscoring the need to fully consider multimorbidity patterns in the assessment, management, and treatment strategies for IBD.