Ulcerative colitis progression: a retrospective analysis of disease burden using electronic medical records

BACKGROUND: Ulcerative colitis (UC) is a debilitating inflammatory bowel disease. Present knowledge regarding UC disease progression over time is limited. OBJECTIVE: To assess UC progression to severe disease along with disease burden and associated factors. METHODS: Electronic medical records linked with Swedish national health registries (2005–2015) were used to identify disease progression of UC. Odds of all-cause and disease-related hospitalization within 1 year were compared between patients with disease progression and those without. Annual indirect costs were calculated based on sick leave, and factors related to UC progression were examined. RESULTS: Of the 1,361 patients with moderate UC, 24% progressed to severe disease during a median of 5.2 years. Severe UC had significantly higher odds for all-cause (OR [odds ratio] 1.47, 95% CI [confidence interval]: 1.12–1.94, P < 0.01) and UC-related hospitalization (OR 2.47, 95% CI: 1.76–3.47, P < 0.0001) compared to moderate disease. Average sick leave was higher in patients who progressed compared to those who did not (64.4 vs 38.6 days, P < 0.001), with higher indirect costs of 151,800 SEK (16,415 €) compared with 92,839 SEK (10,039 €) (P < 0.001), respectively. UC progression was related to young age (OR 1.62, 95% CI: 1.17–2.25, P < 0.01), long disease duration (OR 1.09, 95% CI: 1.03–1.15, P < 0.001), and use of corticosteroids (OR 2.49, 95% CI: 1.67–3.72, P < 0.001). CONCLUSION: Disease progression from moderate to severe UC is associated with more frequent and longer hospitalizations and sick leave. Patients at young age with long disease duration and more frequent glucocorticosteroid medication are associated with progression to severe UC.