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Crohn’s disease: increased mortality 10 years after diagnosis in a Europe-wide population based cohort
  1. F L Wolters1,
  2. M G Russel2,
  3. J Sijbrandij3,
  4. L J Schouten4,
  5. S Odes5,
  6. L Riis6,
  7. P Munkholm6,
  8. P Bodini7,
  9. C O’Morain8,
  10. I A Mouzas9,
  11. E Tsianos10,
  12. S Vermeire11,
  13. E Monteiro12,
  14. C Limonard3,
  15. M Vatn13,
  16. G Fornaciari14,
  17. S Pereira15,
  18. B Moum13,
  19. R W Stockbrügger1,
  20. on behalf of the European Collaborative study group on Inflammatory Bowel Disease (EC-IBD)
  1. 1Department of Gastroenterology and Hepatology, University Hospital Maastricht, Maastricht, the Netherlands
  2. 2Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
  3. 3MEMIC, Centre for Data and Information Management, Maastricht, the Netherlands
  4. 4Department of Epidemiology, NUTRIM, Maastricht University, Maastricht, the Netherlands
  5. 5Gastroenterology Unit, Soroka University Hospital, Ben Gurion University, Beer Sheva, Israel
  6. 6Department of Medical Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
  7. 7Servizio di Gastroenterologia, Ospedale di Cremona, Cremona, Italy
  8. 8Adelaide and Meath Hospital, Department of Gastroenterology, Trinity College, Tallaght, Dublin, Ireland
  9. 9Department of Gastroenterology, University General Hospital, Heraklion, Crete, Greece
  10. 10Division of Internal Medicine, University of Ioannina, Ioannina, Greece
  11. 11Department of Gastroenterology, UZ Gasthuisberg, Universiteit Leuven, Leuven, Belgium
  12. 12University Hospital of Santa Maria, Lisboa, Portugal
  13. 13Hospital Oestfold Frederikstad, Department of Medicine, Section for Gastroenterology, Fredrikstad, Norway
  14. 14Department of Internal Medicine and Gastroenterology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
  15. 15Hospital Xeral de Vigo, Vigo, Spain
  1. Correspondence to:
    Dr F L Wolters
    Department of Gastroenterology and Hepatology, PO Box 5800, 6202 AZ Maastricht, the Netherlands; fwolters{at}viecuri.nl

Abstract

Background: No previous correlation between phenotype at diagnosis of Crohn’s disease (CD) and mortality has been performed. We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.

Methods: Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled, uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993. Standardised mortality ratios (SMRs) were calculated for geographic and phenotypic subgroups at diagnosis.

Results: Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected (SMR 1.85 (95% CI 1.30–2.55)). Mortality risk was significantly increased in both females (SMR 1.93 (95% CI 1.10–3.14)) and males (SMR 1.79 (95% CI 1.11–2.73)). Patients from northern European centres had a significant overall increased mortality risk (SMR 2.04 (95% CI 1.32–3.01)) whereas a tendency towards increased overall mortality risk was also observed in the south (SMR 1.55 (95% CI 0.80–2.70)). Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis. Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes. Excess mortality was mainly due to gastrointestinal causes that were related to CD.

Conclusions: This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis, and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.

  • CD, Crohn’s disease
  • CCS, clinical classifications software
  • EC-IBD, European Collaborative study group of Inflammatory Bowel Disease
  • IBD, inflammatory bowel disease
  • ICD, International Classification of Diseases
  • LTFU, lost to follow up
  • SMR, standardised mortality ratio
  • TNF-α, tumour necrosis factor α
  • WHO, World Health Organisation
  • mortality
  • Crohn’s disease
  • population based
  • cohort

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Footnotes

  • Published online first 8 September 2005

  • This study was granted by the European Commission as a fifth framework shared cost action (QLG4-CT-2000-01414)

  • Conflict of interest: None declared.

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