Crohn's disease: increased mortality 10 years after diagnosis in a Europe-wide population based cohort.
BACKGROUND
No previous correlation between phenotype at diagnosis of Crohn's disease (CD) and mortality has been performed. We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.


METHODS
Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled, uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993. Standardised mortality ratios (SMRs) were calculated for geographic and phenotypic subgroups at diagnosis.


RESULTS
Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected (SMR 1.85 (95% CI 1.30-2.55)). Mortality risk was significantly increased in both females (SMR 1.93 (95% CI 1.10-3.14)) and males (SMR 1.79 (95% CI 1.11-2.73)). Patients from northern European centres had a significant overall increased mortality risk (SMR 2.04 (95% CI 1.32-3.01)) whereas a tendency towards increased overall mortality risk was also observed in the south (SMR 1.55 (95% CI 0.80-2.70)). Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis. Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes. Excess mortality was mainly due to gastrointestinal causes that were related to CD.


CONCLUSIONS
This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis, and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.
Wolters
F L
FL
Department of Gastroenterology and Hepatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands. fwolters@viecuri.nl
Russel
M G
MG
Sijbrandij
J
J
Schouten
L J
LJ
Odes
S
S
Riis
L
L
Munkholm
P
P
Bodini
P
P
O'Morain
C
C
Mouzas
I A
IA
Tsianos
E
E
Vermeire
S
S
Monteiro
E
E
Limonard
C
C
Vatn
M
M
Fornaciari
G
G
Pereira
S
S
Moum
B
B
Stockbrügger
R W
RW
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003424:Crohn Disease / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors