Miller SD¹, Cuffari C¹, Akhuemonkhan E², Guerrerio AL¹, Lehmann H³, Hutfless S^4,5. Pediatr Gastroenterol Hepatol Nutr. 2019 Mar;22(2):152-161. doi: 10.5223/pghn.2019.22.2.152. Epub 2019 Feb 27.

Author information

1 Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

2 Department of Allopathic Internal Medicine Residency, The Wright Center for Graduate Medical Education, Scranton, PA, USA.

3 Division of Health Science Informatics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

4 Division of Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

5 Division of Gastroenterology and Hepatology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Abstract

PURPOSE: We examined the prevalence of anemia, annual screening for anemia, and treatment of anemia with iron among children with inflammatory bowel disease (IBD).

METHODS: A retrospective study of U.S. pediatric patients with IBD was performed in the MarketScan commercial claims database from 2010-2014. Children (ages 1-21) with at least two inpatient or outpatient encounters for IBDwho had available lab and pharmacy data were included in the cohort. Anemia was defined using World Health Organization criteria. We used logistic regression to determine differences in screening, incident anemia, and treatment based on age at first IBD encounter and sex.

RESULTS: The cohort (n=2,446) included 1,560 Crohn's disease (CD) and 886 ulcerative colitis (UC). Approximately, 85% of CD and 81% of UC were screened for anemia. Among those screened, 51% with CD and 43% with UC had anemia. Only 24% of anemia patients with CD and 20% with UC were tested for iron deficiency; 85% were iron deficient. Intravenous (IV) iron was used to treat 4% of CD and 4% UC patients overall and 8% of those with anemia.

CONCLUSION: At least 80% of children with IBD were screened for anemia, although most did not receive follow-up tests for iron deficiency. The 43%-50% prevalence of anemia was consistent with prior studies. Under-treatment with IV iron points to a potential target for quality improvement.