Survival and cause-specific mortality in patients with inflammatory bowel disease: a long-term outcome study in Olmsted County, Minnesota, 1940-2004

Tine Jess ¹, Edward V Loftus Jr ^2*, W. Scott Harmsen ², Alan R Zinsmeister ², William J Tremaine ², L Joseph Melton ², Pia Munkholm ¹ and William J Sandborn ²

¹ Herlev University Hospital, Denmark
² Mayo Clinic College of Medicine, United States

^* To whom correspondence should be addressed. E-mail: loftus.edward{at}mayo.edu.

Accepted 5 January 2006

Abstract

Background and Aims: We followed a population- based cohort of patients with IBD from Olmsted County, Minnesota in order to analyze long-term survival and cause-specific mortality.

Material and Methods: Six-hundred-ninety-two patients were followed for a median of 14 years. Standardized mortality ratios (SMR, observed/expected deaths) were calculated for specific causes of death. Cox proportional hazards regression was used to determine if clinical variables were independently associated with mortality.

Results: Fifty-six of 314 Crohn's disease patients died versus 46.0 expected (SMR, 1.2; 95% CI, 0.9-1.6), and 62 of 378 ulcerative colitis (UC) patients died versus 79.2 expected (SMR, 0.8; 95% CI, 0.6-1.0). Eighteen patients with Crohn's disease (32%) died from disease-related complications, and 12 patients (19%) died from causes related to UC. In Crohn's disease, an increased risk of dying from non-malignant gastrointestinal causes (SMR, 6.4; 95% CI, 3.2-11.5), gastrointestinal malignancies (SMR, 4.7; 95% CI, 1.7- 10.2), and chronic obstructive pulmonary disease (COPD) (SMR, 3.5; 95% CI, 1.3-7.5) was observed. In UC, cardiovascular death was reduced (SMR, 0.6; 95% CI, 0.4- 0.9). Increased age at diagnosis and male gender were associated with mortality in both subtypes. In UC but not Crohn's disease, a diagnosis after 1980 was associated with decreased mortality.

Conclusions: In this population-based study of IBD patients from North America, overall survival was similar to that expected in the U.S. White population. Crohn's disease patients were at increased risk of dying from gastrointestinal disease and COPD, whereas UC patients had a decreased risk of cardiovascular death.

Keywords: Crohn's disease, death causes, inflammatory bowel disease, survival, ulcerative colitis

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