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Meta-Analysis
. 2013 Mar;19(3):599-613.
doi: 10.1097/MIB.0b013e31827f27ae.

Crohn's disease and ulcerative colitis are associated with elevated standardized mortality ratios: a meta-analysis

Meenakshi Bewtra  1 , Lisa M Kaiser, Tom TenHave, James D Lewis
Affiliations
Meta-Analysis

Crohn's disease and ulcerative colitis are associated with elevated standardized mortality ratios: a meta-analysis

Meenakshi Bewtra et al. Inflamm Bowel Dis. 2013 Mar.

Abstract

Background: Evidence regarding all-cause and cause-specific mortality in inflammatory bowel disease (IBD) is conflicting, and debate exists over appropriate study design to examine these important outcomes. We conducted a comprehensive meta-analysis of all-cause and cause-specific mortality in both Crohn's disease (CD) and ulcerative colitis (UC), and additionally examined various effects of study design on this outcome.

Methods: A systematic search of PubMed and EMBASE was conducted to identify studies examining mortality rates relative to the general population. Pooled summary standardized mortality ratios (SMR) were calculated using random effect models.

Results: Overall, 35 original articles fulfilled the inclusion and exclusion criteria, reporting all-cause mortality SMRs varying from 0.44 to 7.14 for UC and 0.71 to 3.20 for CD. The all-cause mortality summary SMR for inception cohort and population cohort UC studies was 1.19 (95% confidence interval, 1.06-1.35). The all-cause mortality summary SMR for inception cohort and population cohort CD studies was 1.38 (95% confidence interval, 1.23-1.55). Mortality from colorectal cancer, pulmonary disease, and nonalcoholic liver disease was increased, whereas mortality from cardiovascular disease was decreased.

Conclusions: Patients with UC and CD have higher rates of death from all causes, colorectal-cancer, pulmonary disease, and nonalcoholic liver disease.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Identification of studies for meta-analysis.
FIGURE 2
FIGURE 2
SMRs for UC (A) and CD (B). The SMR from individual trials is denoted with inception cohort studies in gray and population cohort studies in black. Horizontal bars represent 95% CIs. The final 3 values represent the overall all-cause SMR for inception cohort studies, population cohort studies, or inception and population cohort studies combined.
FIGURE 3
FIGURE 3
Cumulative meta-analysis of all-cause mortality. The cumulative SMR is shown for UC (A) and CD (B). Each entry represents the cumulative SMR for the study listed combined with all previous studies above the entry. The cumulative SMR from inception cohort studies only are in black closed circles, whereas the results from population-plus-inception cohort studies are given by gray open squares. Horizontal bars represent 95% CIs.
See this image and copyright information in PMC

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