Low mortality in ulcerative colitis and Crohn's disease in three regional centers in England

OBJECTIVES: Recent epidemiological studies suggest that mortality rates for inflammatory bowel disease (IBD) are similar to those of the general popul ation. However, most of this work has been done in referred populations or larger urban centers. We intended to estimate mortality rates for ulcerativ e colitis (UC) and Crohn's disease (CD) in three British district general h ospital practices in Wolverhampton, Salisbury, and Swindon. METHODS: Consecutive patients with CD or UC were identified from 1978 to 19 86 and followed prospectively. Demographic data, date and cause of death or health status at December 31, 1993 were used to estimate standardized mort ality ratios (SMRs) and 95% confidence intervals. RESULTS: Sixty-four deaths occurred in 552 patients (UC 41 of 356; CD 23 of 196). The overall SMRs were 103 [95% confidence interval (CI): 79-140] for UC and 94 (95% CI: 59-140) for CD. The respective SMRs were higher only in the first year after diagnosis at 223 (95% CI: 99-439; p 0.02) and 229 (74 -535; p = 0.056), and even then, most subjects died from non-IBD causes (5 of 13). Nonsurvivors were significantly older than survivors in both UC and CD (p < 0.01). The SMR was also significantly greater during a severe firs t attack of UC at 310 (95% CI: 84-793; p = 0.04). Patients with perianal or colonic CD had an increased SMR [396 (95% CI: 108-335; p = 0.02) and 164 ( 95% CI: 82-335; p = 0.02)] respectively, partly related to the older mean a ge (52 vs 32 yr, p < 0.001). CONCLUSIONS: Mortality rates are not increased in IBD compared with the gen eral population. However, older patients may be at increased risk of dying from other causes early in the disease clinical course. (C) 2001 by Am. Cel l. of Gastroenterology.