Trends in overall and cause-specific mortality among patients with inflammatory bowel disease from 1982 to 2010

Abstract

Background & aims: Treatments for inflammatory bowel diseases (IBDs) such as ulcerative colitis (UC) and Crohn's disease (CD) have changed over time, with unclear effects on prognosis. We assessed overall and cause-specific mortality in a Danish cohort of patients with IBD during a 30-year time period.

Methods: We compared data from 36,080 patients with UC and 15,361 with CD, who were diagnosed in Denmark from 1982 to 2010, and compared them with data from 2,858,096 matched individuals from the general population (controls). Overall and cause-specific mortality were estimated by Cox regression analysis, adjusted for age, sex, disease duration, and known comorbidities before IBD diagnosis. Results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: Mortality greatly increased in the first year after individuals were diagnosed with IBD; intermediate-term and long-term mortalities increased by approximately 10% among individuals with UC and 50% among those with CD, compared with the general population. Compared with the time period of 1982-1989, overall mortalities decreased among patients diagnosed with UC from 1990 to 1999 (HR, 0.96; 95% CI, 0.90-1.02) and from 2000 to 2010 (HR, 0.88; 95% CI, 0.82-0.95). These reductions were mainly due to decreased mortality from colorectal cancer, gastrointestinal disorders, and suicide. For individuals with CD, mortality did not change among these time periods because of long-term increases in mortality from infections, cancer, respiratory diseases, and gastrointestinal diseases.

Conclusions: In a Danish cohort, mortality from UC decreased from 1982 to 2010, largely because of reduced mortalities from gastrointestinal disorders and colorectal cancer. People with CD had 50% greater mortality than the general population, and this value did not change during this time period.