Anemia in Inflammatory Bowel Disease: Practice Patterns and Clinical Outcomes in a Large National Veterans Cohort.

Background: Anemia is a common complication of inflammatory bowel disease (IBD), impacting patient quality of life and clinical outcomes. This study examines anemia management practices and clinical outcomes in a national cohort of veterans with IBD.

Methods: A retrospective cohort study of 89 687 veterans with IBD from 2000 to 2017 was conducted using Veterans Health Administration data. We assessed anemia screening, iron store assessments, and iron therapy. Primary outcomes included anemia resolution within 12 months. Secondary outcomes included IBD-related hospitalizations, steroid use, and surgery within five years. Multivariate logistic regression models assessed associations between patient characteristics and clinical outcomes.

Results: Among 89 687 VA patients with IBD, 56% experienced anemia, but only 36% received iron testing. Only 23% of patients with iron deficiency received iron therapy within 6 months. Hemoglobin normalization occurred in 19% within a year. IBD patients with comorbidities had lower resolution rates (1-2 comorbidities: OR 0.89). Over five years, 30% were hospitalized, with lower rates for nonsmokers (OR 0.81) and higher for those with comorbidities (OR 1.10) or on biologics (OR 1.91). Steroid use was 17.5%, higher in those with comorbidities (OR 1.20) or on biologics (OR 4.11), and lower in Black patients (OR 0.78). Only 2% had surgery, less common among Black patients (OR 0.69) and non-smokers (OR 0.72).

Conclusions: Anemia is underdiagnosed and undertreated in veterans with IBD, leading to poor clinical outcomes. Enhanced screening and treatment protocols are essential to improve anemia resolution rates and reduce IBD-related complications.