Mortality in Patients with Inflammatory Bowel Disease: Results from 30 Years of Follow-up in a Norwegian Inception Cohort (the IBSEN study)

Abstract

Background and aims Patients with longstanding inflammatory bowel disease (IBD) may be at an increased risk of death compared to the general population, especially elderly patients. The Inflammatory Bowel South-Eastern Norway (IBSEN) study has previously detected a small but not statistically significant increase in mortality, 20 years after diagnosis. The aim of this study was to evaluate the overall and cause-specific mortality at 30 years of follow-up. Methods The IBSEN cohort included 519 incident patients with ulcerative colitis (UC) and 237 patients with Crohn’s disease (CD) between 1990 and 1993, each matched with five controls. Death certificate data were obtained from the Norwegian Cause of Death Registry. The underlying causes of death were categorised into five groups: all cancers, gastrointestinal cancers, cardiovascular diseases, infections, and all other causes. Hazard ratios (HR) were modelled using Cox regression. Results There was no statistically significant difference in the overall mortality rates. However, in patients with CD, male sex (HR = 1.65 [1.04-2.62]), onset after 40 years of age (HR = 1.72 [95% CI: 1.19-2.48]), colonic disease (HR = 1.57 [1.05-2.35]), and penetrating behavior (HR = 3.3 [1.41-7.76]) were clinical factors associated with an increased mortality. IBD patients were at a higher risk of death due to cardiovascular disease; HR = 1.51 [1.10-2.08] for UC and 2.04 [1.11-3.77] for CD. When taking into account both the underlying and the immediate cause of death, infection was more frequent in patients with IBD. Conclusions Overall, all-cause mortality rates were similar between patients with IBD and controls. However, clinicians should remain alert to cardiovascular diseases and infections, particularly in specific subgroups of CD patients.

Similar geographic distributions of death rates from inflammatory bowel disease and Hodgkin lymphoma or multiple sclerosis

“…The collection of vital statistics using the ICD‐codes has been a common practice in all developed countries for more than a century and is unlikely to vary three‐ to tenfold among different countries. Mortality in IBD patients is mostly associated with cardiovascular disease rather than with the disease itself 13 . However, for the purpose the present epidemiologic analysis, the occurrence of death itself is of secondary relevance, as it only serves as a marker of disease occurrence and as a means of gathering healthcare information that is stratified by country (geography), medical diagnosis, and age.…”

“…Mortality in IBD patients is mostly associated with cardiovascular disease rather than with the disease itself. 13 However, for the purpose the present epidemiologic analysis, the occurrence of death itself is of secondary relevance, as it only serves as a marker of disease occurrence and as a means of gathering healthcare information that is stratified by country (geography), medical diagnosis, and age. If mortality were a poor parameter of disease occurrence and more precise parameters became available, they might show even stronger correlations.…”

Risk of Cancer in Patients With Crohn’s Disease 30 Years After Diagnosis (the IBSEN Study)

“…Lastly, in a previous study, after 30 years of follow-up, patients with CD of the IBSEN cohort did not have significantly higher mortality with cancer as the underlying cause of death. 25 …”

Matrisome gene expression is altered during non-allometric heart growth in genetically enlargedDrosophila

“…However, there are a wide variety of conditions that are at increased risk of developing CVD, including those with chronic kidney disease, inflammatory bowel disease, Marfan syndrome, and acromegaly. CVD is the leading cause of death for all of these conditions (Jankowski et al 2021; Follin-Arbelet et al 2023; Schicho, Marsche, and Storr 2015; Vanem et al 2018; Kamenický, Maione, and Chanson 2021). In some conditions, like acromegaly, even individuals with pharmacologically managed disease remain at increased risk of developing CVD (Wolters et al 2020).…”