title: Nationwide linkage analysis in Scotland to assess mortality following hospital admission for Crohn's disease: 1998-2000.
abstract: BACKGROUND
  Although population-based studies of patients with Crohn's disease (CD) suggest only a modestly increased mortality, recent data have raised concerns regarding the outcome of CD patients requiring hospitalisation.
  
  
  OBJECTIVE
  To determine the mortality and contributory factors in 1595 patients hospitalised for CD in Scotland between 1998 and 2000.
  
  
  METHODS
  The Scottish Morbidity Records database and linked datasets were used to assess longitudinal patient outcome, and to explore associations between 3-year mortality and age, sex, comorbidity, admission type and social deprivation. The standardised mortality ratio (SMR) at 3 years from admission was calculated with reference to the Scottish population.
  
  
  RESULTS
  The SMR was 3.31 (95% confidence interval 2.80-3.89). This was increased in all patients, other than those <30 years at presentation, and was highest in patients aged 50-64 years (SMR 4.84 [3.44-6.63]). On multivariate analysis, age >50, admission type, comorbidity, social deprivation and length of admission were significantly associated with mortality. Other than age, admission type was the strongest factor predictive of death. Three-year crude mortality was 0.3% for elective surgical, 8.7% for emergency surgical, 8.3% for elective nonsurgical and 12.7% for emergency nonsurgical admission (P < 0.001).
  
  
  CONCLUSIONS
  The study demonstrates high mortality rates in patients hospitalised during 1998-2000 for CD, especially in patients over 50. Elective surgery is associated with lower mortality than emergency surgery or medical therapy. Further study is needed to determine whether these patterns have changed following the introduction of biological treatment.
authors: Molecular Medicine Centre, Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, UK.
authors: N A
authors: NA
authors: Kennedy
authors: D N
authors: DN
authors: Clark
authors: J
authors: J
authors: Bauer
authors: A M
authors: AM
authors: Crowe
authors: A D
authors: AD
authors: Knight
authors: R J
authors: RJ
authors: Nicholls
authors: J
authors: J
authors: Satsangi
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D003424:Crohn Disease / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D016019:Survival Analysis; D055815:Young Adult