All-cause and cause-specific mortality in inflammatory bowel disease across the biologic era: a population-based matched cohort study.
Inflammatory bowel disease (IBD) is associated with increased mortality, but whether death rates and causes of death have changed across the biologic era is unclear. We aimed to assess all-cause and cause-specific mortality in Crohn's disease (CD) and ulcerative colitis (UC) across therapeutic eras.
We conducted a retrospective, population-based matched cohort study (1984-2019). IBD cases were matched 1:10 to unaffected controls by age, sex, and geography. Follow-up was stratified into a pre-biologic era (1984-2000) and biologic era (2001-2019). All-cause mortality was assessed using Cox models and cause-specific mortality using competing-risk methods.
We identified 13 306 patients with IBD (5955 CD; 7351 UC) and 133 060 matched controls. During follow-up, 2156 patients with IBD (16.2%) and 19 095 controls (14.4%) died. CD was associated with higher all-cause mortality than controls (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.19-1.37). UC mortality did not differ from controls (HR 1.03, 95% CI 0.97-1.10). In era-stratified analyses, mortality was comparable in the pre-biologic era (IBD HR 1.04, 95% CI 0.93-1.15). In the biologic era, excess mortality was observed in CD (HR 1.34, 95% CI 1.24-1.45) but not in UC (HR 1.05, 95% CI 0.98-1.12). Compared with controls, CD had higher mortality from colorectal cancer (HR 2.28), renal disease (HR 2.79), non-Hodgkin lymphoma (HR 1.89), and sepsis (HR 2.12), while UC had higher mortality from colorectal cancer (HR 1.56) and cholangiocarcinoma (HR 3.21).
All-cause mortality was modestly higher in CD, while UC mortality was similar to matched controls. The CD mortality gap appeared most evident with longer follow-up.
We conducted a retrospective, population-based matched cohort study (1984-2019). IBD cases were matched 1:10 to unaffected controls by age, sex, and geography. Follow-up was stratified into a pre-biologic era (1984-2000) and biologic era (2001-2019). All-cause mortality was assessed using Cox models and cause-specific mortality using competing-risk methods.
We identified 13 306 patients with IBD (5955 CD; 7351 UC) and 133 060 matched controls. During follow-up, 2156 patients with IBD (16.2%) and 19 095 controls (14.4%) died. CD was associated with higher all-cause mortality than controls (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.19-1.37). UC mortality did not differ from controls (HR 1.03, 95% CI 0.97-1.10). In era-stratified analyses, mortality was comparable in the pre-biologic era (IBD HR 1.04, 95% CI 0.93-1.15). In the biologic era, excess mortality was observed in CD (HR 1.34, 95% CI 1.24-1.45) but not in UC (HR 1.05, 95% CI 0.98-1.12). Compared with controls, CD had higher mortality from colorectal cancer (HR 2.28), renal disease (HR 2.79), non-Hodgkin lymphoma (HR 1.89), and sepsis (HR 2.12), while UC had higher mortality from colorectal cancer (HR 1.56) and cholangiocarcinoma (HR 3.21).
All-cause mortality was modestly higher in CD, while UC mortality was similar to matched controls. The CD mortality gap appeared most evident with longer follow-up.