Most Patients With Crohn’s Disease Meet Moderate-to-High Risk Criteria
A large claims-based analysis suggests that the majority of adults with Crohn’s disease (CD) meet the American Gastroenterological Association (AGA) definition of moderate-to-high (M/H) risk and experience greater health care utilization than low-risk patients.
Investigators used the Healthcare Integrated Research Database, which includes commercially insured and Medicare Advantage populations across the United States, to identify adults diagnosed with CD between 2019 and 2024. Because claims data often lack key clinical details required for AGA risk stratification, such as anatomic involvement, the study incorporated medical record abstraction for a subset of 700 patients to enable accurate classification.
Among 7835 eligible patients, the mean age was 49 years, and just over half were female. Within the abstracted cohort, 70.0% met AGA-defined M/H risk criteria. Compared with low-risk patients, those classified as M/H risk were younger and less likely to be female. They also underwent more diagnostic testing and imaging, including CT and MRI, and experienced higher rates of CD-related surgery.
Health care resource utilization was consistently higher among M/H risk patients. Inpatient admissions occurred in 17.3% of M/H risk patients compared with 10.0% of low-risk patients, and emergency department visits were reported in 27.3% versus 19.0%, respectively. Despite this burden, only about half of M/H risk patients received advanced therapy during the same year.
The authors noted that “70% of CD patients met the AGA definition of M/H risk,” yet only 52.4% were treated with advanced therapies. They further reported that patients at M/H risk had “higher rates of inpatient and ED use, imaging, surgeries, and diagnostic testing than low risk patients.”
For gastroenterologists, the key takeaway is that M/H risk CD is common and associated with substantial health care utilization. These data underscore the importance of accurate risk stratification and suggest that many patients who meet criteria for higher-risk disease may remain undertreated. Integrating clinical data with claims-based insights may help identify patients who could benefit from earlier escalation to advanced therapy and closer monitoring.
Reference
Head M, Patel A, Chen HY, et al. Real-world risk stratification in Crohn’s disease: patterns in diagnosis, treatment, and utilization, Inflammatory Bowel Diseases, Volume 32, Issue Supplement_1, February 2026, izag006.032, https://doi.org/10.1093/ibd/izag006.032
