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Crohn’s disease: why the disparity in mortality?
  1. E V Loftus Jr
  1. Correspondence to:
    Dr E V Loftus Jr
    Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA; loftus.edward{at}mayo.edu

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There has been no significant decrease in mortality in patients with Crohn’s disease over the last several decades

It is well accepted that Crohn’s disease is associated with a small but real risk of death. Population based reports from Sweden,1,2 Denmark,3 and Italy4 indicate that Crohn’s disease patients have a higher mortality rate than expected, although at least one notable exception from the UK demonstrated survival similar to the general population (table 1).5 A preliminary report from Olmsted County, Minnesota, indicated a mortality rate that was about 20% higher (but not significantly different statistically) than that expected,6 standing in contrast with the results of a previous report from the same location.7 The largest study of mortality in Crohn’s disease was from a cohort of approximately 6000 patients identified through the General Practice Research Database (GPRD), which contains the computerised medical records of 6% of the British population.8 The annual mortality rate in Crohn’s disease was 1.6% compared with 1.0% in age, sex, and practice matched controls. After adjusting for age, sex, and cigarette smoking, it appeared that the risk of death was 73% higher in Crohn’s disease patients than in controls.8 Although the large cohort size makes this study important, its generalisability is limited by the fact that the cohort was a mixture of incidence and prevalence cases, the average age at entry into the cohort was 42 years (higher than the average age at diagnosis of Crohn’s disease of late 20s/early 30s in most studies), and the average follow up was only three years. A recent systematic review of “hard end points” in population based cohorts of Crohn’s disease concluded that there was no evidence for a significant change in disease outcome over the past 40 years.9 To summarise, …

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