Lori A. Daiello, ScM1, Tingting Zhang, PhD1, Yoojin Lee, MS, MPH1, Andrew R. Zullo, PharmD, PhD1, Jessica Abel, MPH2, Douglas Taylor, MBA3; 1Brown University School of Public Health, Providence, RI; 2AbbVie, Madison, NJ; 3Ironwood Pharmaceuticals, Boston, MA
Introduction: Little is known about the current burden of chronic constipation (CC) among nursing home (NH) residents. This study describes the epidemiology of CC and utilization of drug therapy for constipation (DTC). Methods: We conducted two retrospective cohort studies of long-stay NH residents ≥ 65 years utilizing (a) electronic health record (EHR) data from 2016 for 126 U.S. NHs [EHR cohort], and (b) national Medicare claims from 2014-2016; [Medicare cohort]. These data were linked with federally-mandated Minimum Data Set (MDS) resident assessments to obtain resident characteristics. The baseline period was defined as the 100 days prior to the index date (NH long-stay qualification date). Follow-up continued until death or the last available MDS assessment or drug order. CC was defined by 1) chronic DTC use, and/or 2) the MDS indicator for constipation. We calculated CC prevalence, baseline characteristics, and DTC use, as well as hospitalizations and estimated costs for the Medicare cohort. Results: In the EHR cohort, 25,739 residents (71.8%) met the CC definition. Mean follow-up was 0.6 years, and the prevalence rate was 1.2 CC episodes per person-year (Table 1). Among individuals with prevalent CC, 86% received a DTC for an average of 18.7 days per person-month. In the Medicare cohort, 245,578 residents (37.5%) had CC. Mean follow-up was 1.5 years, with a prevalence rate of 0.23 per person-year. Relative to the EHR cohort, fewer individuals with prevalent CC (62%) received a DTC during an average of 9.7 days per person-month of follow-up; utilization also differed (Table 2). ~8% had a constipation-related hospitalization during follow-up, with paralytic ileus being the most frequent diagnosis. The average cost of constipation-related admissions accounted for 16% of the average cost for all-cause hospitalizations. Discussion: Relying on Medicare data alone likely undercounts CC cases and DTC use because Part D claims lack the OTC drug data that characterizes most constipation treatment. For this reason, EHR data sources are preferred for CC research in NH settings. CC and cognitive impairment frequently co-occur, adding to the burden of treatment that includes OTC laxative polypharmacy and time-consuming administration of products not well-accepted by NH residents with dementia (e.g. laxative powders requiring mixture with liquid, suppositories). An individualized approach to CC treatment could be more effective and reduce severe adverse events.
Disclosures: Lori Daiello: Allergan plc (now AbbVie) – Grant/Research Support. Ironwood Pharmaceuticals Inc. – Grant/Research Support. Tingting Zhang indicated no relevant financial relationships. Yoojin Lee indicated no relevant financial relationships. Andrew Zullo indicated no relevant financial relationships. Jessica Abel: AbbVie – Employee. Douglas Taylor: Ironwood Pharmaceuticals – Employee.