Mapping the relationships between inflammatory bowel disease and comorbid diagnoses to identify disease associations

Akbar K. Waljee, VA Ann Arbor Health Care System
Mohamed Noureldin, Michigan Medicine
Jeffrey A. Berinstein, Michigan Medicine
Shirley A. Cohen-Mekelburg, VA Ann Arbor Health Care System
Beth I. Wallace, VA Ann Arbor Health Care System
Kelly C. Cushing, Michigan Medicine
David A. Hanauer, University of Michigan
Toby P. Keeney-Bonthrone, St. Joseph Mercy Hospital
Brahmajee Nallamothu, VA Ann Arbor Health Care System
Peter D.R. Higgins, Michigan Medicine


© 2020 Thieme Medical Publishers, Inc.. All rights reserved. Background Massive amounts of patient data are captured daily in electronic medical records (EMR). Utilizing the power of such large data may help identify disease associations and generate hypotheses that can lead to a better understanding of disease associations and mechanisms. We aimed to comprehensively identify and validate associations between inflammatory bowel disease (IBD) and concurrent comorbid diagnoses. Methods We performed a cross-sectional study using EMR data collected between 1986 and 2009 at a large tertiary referral center to identify associations with a diagnosis of IBD. The resulting associations were externally validated using the Truven MarketScan database, a large nationwide dataset of private insurance claims. Results A total of 6225 IBD patients and 31 125 non-IBD controls identified using EMR data were used to abstract 41 comorbid diagnoses associated with an IBD diagnosis. The strongest associations included Clostridiodes difficile infection, pyoderma gangrenosum, parametritis, pernicious anemia, erythema nodosum, and cytomegalovirus infection. Two IBD association clusters were found, including diagnoses of nerve conduction abnormalities and nonspecific inflammatory conditions of organs outside the gut. These associations were validated in a national cohort of 80 907 patients with IBD and 404 535 age- and sex-matched controls. Conclusion We leveraged a big data approach to identify several associations between IBD and concurrent comorbid diagnoses. EMR and big data provide the opportunity to explore disease associations with large sample sizes. Further studies are warranted to refine the characterization of these associations and evaluate their usefulness for increasing our understanding of disease associations and mechanisms.