Mental Health Disorders, Smoking Linked to Medication Nonadherence in Pediatric Crohn Disease

Researchers examined contributing factors for treatment nonadherence among adolescents hospitalized with Crohn disease.

Mental health disorders and smoking are independently associated with medication nonadherence among adolescent patients hospitalized with Crohn disease (CD), according to study results published in the Annals of Medicine.

The cross-sectional study used discharge data of pediatric patients aged younger than 20 years from the 2016 Kid’s Inpatient Database. All participants had a hospitalization with an International Classification of Diseases (ICD)-10 code indicating CD.

A total of 2439 CD hospitalizations were included in the analysis — 113 patients had an ICD-10 code for a diagnosis of nonadherence and were compared with the 2326 patients without such a diagnosis.

The median age of the nonadherent group was 17 (IQR, 13-19) years and 17 (IQR 14-19) years for the control group (P =.46). Of the included participants, 2280 (94%) were in the adolescent age range. Among the nonadherent group, 49.6% were girls vs 47.5% of the control group (P =.7).

The nonadherent cohort had significantly more diagnoses related to smoking (15.9 vs 5.5%, P <.001) and cannabis use (5.3 vs 1.5%, P = .009) vs the control group, respectively.

A significantly greater number of any mental health diagnosis was observed in the nonadherent group compared with the control group (38 [33.6%] vs 444 [19.1%], P <.001). A significantly greater number of patients with a diagnosis of depression (19.5 vs 9%, P =.001) and schizoaffective disorder (5.3 vs 0.3%, P <.001) was also found in the nonadherent cohort compared with the control group, respectively.

A diagnosis of schizoaffective disorder (odds ratio [OR], 10.6; 95% CI, 3.3-34.5), depression (OR, 1.9; 95% CI, 1.1-3.2), and indication of smoking use (OR, 2.3; 95% CI, 1.3-4.1) were all significantly and independently associated with a diagnosis of nonadherence, according to a logistic regression analysis that included variables with a significance of less than 0.1 and corrected for age and sex.

Study limitations included the use of ICD-10 codes, and it was not possible to determine the exact reason for admission and current medications. Also, the database did not report data on an individual basis and so it was not possible to track repeated hospitalizations or surgeries and longitudinal outcomes.

“The results of our study should raise the awareness of the treating physician to these and other related conditions, which may negatively impact disease outcomes both in the short and long term,” the study authors noted. “A multidisciplinary approach including pediatric inflammatory bowel disease specialists, psychiatrists, and addiction specialists is required in order to tackle this issue holistically and improve adherence to medical therapy.”

Reference

Cohen NA, Micic DM, Sakuraba A. Factors associated with poor compliance amongst hospitalized, predominantly adolescent pediatric Crohn’s disease patients. Ann Med. 2022;54(1):886-892. doi:10.1080/07853890.2022.2057582