Mortality in patients with Crohn’s disease in Örebro, Sweden 1963–2010

Abstract

Background

Some studies have suggested a reduced life expectancy in patients with Crohn’s disease (CD) compared with the general population. The evidence, however, is inconsistent.

Aims

Prompted by such studies, we studied survival of CD patients in Örebro county, Sweden.

Methods

From the medical records, we identified all patients diagnosed with CD during 1963–2010 with follow-up to the end of 2011. We estimated: overall survival, net and crude probabilities of dying from CD, relative survival ratio (RSR), and excess mortality rate ratios (EMRR) at 10-year follow-up.

Results

The study included 492 patients (226 males, 266 females). Median age at diagnosis was 32 years (3–87). Net and crude probabilities of dying from CD increased with increasing age and were higher for women. Net survival of patients aged ≥60 at diagnosis was worse for patients diagnosed during 1963–1985 (54%) than for patients diagnosed during 1986–1999 (88%) or 2000–2010 (93%). Overall, CD patients’ survival was comparable to that in the general population [RSR = 0.98; 95% CI: (0.95–1.00)]. However, significantly lower than expected survival was suggested for female patients aged ≥60 diagnosed during the 1963–1985 [RSR = 0.47 (0.07–0.95)]. The adjusted model suggested that, compared with diagnostic period 1963–1985, disease-related excess mortality declined during 2000–2010 [EMRR = 0.36 (0.07–1.96)]; and age ≥60 at diagnosis [EMRR = 7.99 (1.64–39.00), reference: age 40–59], female sex [EMRR = 4.16 (0.62–27.85)], colonic localization [EMRR = 4.20 (0.81–21.88), reference: ileal localization], and stricturing/penetrating disease [EMRR = 2.56 (0.52–12.58), reference: inflammatory disease behaviour] were associated with poorer survival.

Conclusion

CD-related excess mortality may vary with diagnostic period, age, sex and disease phenotype.

Key summary

• There is inconsistent evidence on life expectancy of patients with Crohn’s disease

• Crohn’s disease-specific survival improved over time.

• Earlier diagnosis period, older age at diagnosis, female sex, colonic disease and complicated disease behaviour seems to be associated with excess Crohn’s disease-related mortality.

Keywords:

• Crohn’s disease
• overall survival
• net probability of dying from CD
• crude probability of dying from CD
• relative survival ratio
• excess mortality rate ratio

Acknowledgements

The authors thank David Anderson for language editing.

Ethics approval

The study was approved by the Uppsala Regional Ethics Committee (2010/304 and 2010/304/1).

Authorship statement

Guarantor of the article

Yaroslava Zhulina.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Financial disclosures

Jonas Halfvarson served as speaker and/or advisory board member for AbbVie, Celgene, Celltrion, Dr. Falk Pharma and the Falk Foundation, Ferring, Hospira, Janssen, MEDA, Medivir, MSD, Olink Proteomics, Pfizer, Prometheus Laboratories, Sandoz/Novartis, Shire, Takeda, Thermo Fisher Scientific, Tillotts Pharma, Vifor Pharma, UCB and received grant support from Janssen, MSD, and Takeda.

Additional information

Funding

This work was supported by Örebro University Hospital Research Foundation [grant number OLL-762471].