Ulcerative colitis: no rise in mortality in a European-wide population based cohort 10 years after diagnosis
- O Höie1,
- L J Schouten2,
- F L Wolters3,
- I C Solberg4,
- L Riis5,
- I A Mouzas6,
- P Politi7,
- S Odes8,
- E Langholz9,
- M Vatn10,
- R W Stockbrügger3,
- B Moum11,
- on behalf of the European Collaborative Study Group of Inflammatory Bowel Disease (EC-IBD)
- 1Sörlandet Hospital Arendal, Department of Medicine, Section for Gastroenterology, Arendal, Norway
- 2Department of Epidemiology, NUTRIM, Maastricht University, Maastricht, The Netherlands
- 3Department of Gastroenterology and Hepatology, University Hospital Maastricht, Maastricht, The Netherlands
- 4Medical Department, Ulleval University Hospital, University of Oslo, Norway
- 5Medical Department, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- 6Department of Gastroenterology, University General Hospital, Heraklion, Crete, Greece
- 7Servizio di Gastroenterologia, Ospedale di Cremona, Cremona, Italy
- 8Gastroenterology Unit, Soroka University Hospital, Beer Sheeva, Israel
- 9Department of Internal Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- 10MedGastro, Rikshospitalet, EpiGen Ahus, University of Oslo, Norway
- 11Department of Internal Medicine, Section of Gastroenterology, Aker University Hospital, Oslo, Norway
- Correspondence to:
Dr O Höie
Department of Internal Medicine, PO Box 608, N-4809 Arendal, Norway; olehoeie{at}online.no
- Accepted 26 September 2006
- Revised 8 September 2006
- Published Online First 6 October 2006
Abstract
Background: Population based studies have revealed varying mortality for patients with ulcerative colitis but most have described patients from limited geographical areas who were diagnosed before 1990.
Aims: To assess overall mortality in a European cohort of patients with ulcerative colitis, 10 years after diagnosis, and to investigate national ulcerative colitis related mortality across Europe.
Methods: Mortality 10 years after diagnosis was recorded in a prospective European-wide population based cohort of patients with ulcerative colitis diagnosed in 1991–1993 from nine centres in seven European countries. Expected mortality was calculated from the sex, age and country specific mortality in the WHO Mortality Database for 1995–1998. Standardised mortality ratios (SMR) and 95% confidence intervals (CI) were calculated.
Results: At follow-up, 661 of 775 patients were alive with a median follow-up duration of 123 months (107–144). A total of 73 deaths (median follow-up time 61 months (1–133)) occurred compared with an expected 67. The overall mortality risk was no higher: SMR 1.09 (95% CI 0.86 to 1.37). Mortality by sex was SMR 0.92 (95% CI 0.65 to 1.26) for males and SMR 1.39 (95% CI 0.97 to 1.93) for females. There was a slightly higher risk in older age groups. For disease specific mortality, a higher SMR was found only for pulmonary disease. Mortality by European region was SMR 1.19 (95% CI 0.91 to 1.53) for the north and SMR 0.82 (95% CI 0.45–1.37) for the south.
Conclusions: Higher mortality was not found in patients with ulcerative colitis 10 years after disease onset. However, a significant rise in SMR for pulmonary disease, and a trend towards an age related rise in SMR, was observed.
- 5-ASA, salazopyrine/5-aminosalisylic acid
- AZA/6MP, azathioprine/6-mercaptopurine
- CCS, clinical classification software
- CRC, colorectal cancer
- EC-IBD, European Collaborative Study Group of Inflammatory Bowel Disease
- GCS, glucocorticosteroids
- SMR, standardised mortality ratio
Footnotes
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Published Online First 6 October 2006
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The study was supported by the European Commission (QLG4-CT-2000-01414).
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Competing interests: None.
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The study protocol was approved by the local committees for medical ethics for all participation centres.
