Mortality of Patients With Microscopic Colitis in Sweden

Abstract

BACKGROUND & AIMS: Microscopic colitis is one of the most common causes of chronic diarrhea in older populations. We investigated all-cause and cause-specific mortality in patients with microscopic colitis. METHODS: We conducted a nationwide cohort study of all cases of microscopic colitis (n [ 14,333) diagnosed from 1990 through 2017 in Sweden. Cases of microscopic colitis were identified using SNOMED codes from gastrointestinal histopathology reports collected from Sweden's 28 pathology departments. Each case of microscopic colitis was matched to 5 population comparators (n [ 68,700). Mortality data were ascertained from Sweden's cause of death register. We used Cox proportional hazards modeling to estimate adjusted hazard ratios (aHRs) and 95% CIs. RESULTS: Through December of 2017, we confirmed 3014 deaths in patients with microscopic colitis (27.4/1000 person-years) and 12,534 deaths in matched population comparators (23.3/1000 person-years). This corresponded to a 10-year absolute risk difference of 3.4% (95% CI, 2.1%-4.6%) and an aHR of 1.17 (95% CI, 1.12-1.22). However, further adjustment of models for comorbidity burden reduced the relative risk of death for patients with microscopic colitis (aHR, 0.98; 95% CI, 0.94-1.02). In analyses of cause-specific death, microscopic colitis was associated with an increased risk of gastrointestinal-related death (aHR, 1.68; 95% CI, 1.38-2.05) and infection-related death (aHR, 1.42 ; 95% CI, 1.11-1.83), but not cancer-related death (aHR, 0.83; 95% CI, 0.76-0.91) or cardiovascular-related death (aHR, 1.02; 95% CI, 0.96-1.10). CONCLUSIONS: In a nationwide cohort study in Sweden, we found that patients with microscopic colitis were at increased risk of death. However, the increase appears to be related to higher burden of comorbidities in this population.

Immune‐mediated inflammatory diseases of the gastrointestinal tract: Beyond Crohn's disease and ulcerative colitis

“…MC is frequently missed or confused with diarrhea‐predominant irritable bowel syndrome (IBS), and the symptoms can result in severe impairment in the quality of life. A nationwide cohort study in Sweden found that patients with MC were at increased risk of death with a 10‐year absolute risk difference of 3.4% compared with the population without MC, which may be to be due to a higher burden of comorbidities 76 . The incidence increases with age, with a peak incidence in sixth and seventh decades of life 77 .…”

Letter to the Editor: Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: A Meta-analysis of Individual Patient Data

“…We have previously outlined our method for identifying MC cases in Sweden. [15][16][17] Briefly, we used the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort, 18 a cohort of gastrointestinal histology from all 28 pathology departments in Sweden from January of 1965 until April of 2017. Each pathology report in ESPRESSO includes data on personal identity number, date of biopsy, anatomic location, and morphology according to the Systematized Nomenclature of Medicine (SNOMED) system (CC: M40600 and LC: M47170).…”

Issue Highlights

“…While the morbidity of this condition is well understood and described, 5 there are scant data on its impact on mortality. In this month's Clinical Gastroenterology and Hepatology, Khalili and colleagues 6 address this knowledge gap with their prospective cohort study evaluating the risk of death in patients with microscopic colitis. The investigators matched each of 14,333 cases of microscopic colitis diagnosed in Sweden between 1990-2017 to 5 population comparators.…”