title: Mortality and causes of death in patients with inflammatory bowel disease: a nationwide register study in Finland.
abstract: OBJECTIVE
  Increased mortality has been reported in Crohn's disease (CD) but mostly not in ulcerative colitis (UC). We evaluated the overall and cause-specific mortality in a nationwide cohort of patients with inflammatory bowel disease (IBD) in Finland.
  
  
  METHODS
  A total of 21,964 patients with IBD (16,649 with UC and 5315 with CD) from the Special Reimbursement register were diagnosed 1987-1993 and 2000-2007 and followed up to the end of 2010 by collating these figures with the national computerized Cause-of-Death Register of Statistics Finland. In each cause-of-death category, the number of deaths reported was compared to that expected in general population, and expressed as a standardized mortality ratio (SMR).
  
  
  RESULTS
  Overall mortality was increased among patients with CD (SMR 1.33, 95% confidence interval 1.21-1.46) and UC (1.10, 1.05-1.15). SMR was significantly increased for gastrointestinal causes in CD (6.53, 4.91-8.52) and UC (2.81, 2.32-3.34). Patients with UC were found also to have increased SMR from pulmonary (1.24, 1.02-1.46) and cardiovascular disease (1.14, 1.06-1.22) and cancers of the colon (1.90, 1.38-2.55), rectum (1.79, 1.14-2.69) and biliary tract (5.65, 3.54-8.54), whereas SMR from alcohol-related deaths was decreased (0.54, 0.39-0.71). Patients with CD had a significantly increased SMR for pulmonary diseases (2.01, 1.39-2.80), infections (4.27, 2.13-7.63) and cancers of the biliary tract (4.51, 1.23-11.5) and lymphoid and hematopoietic tissue (2.95, 1.85-4.45).
  
  
  CONCLUSIONS
  In this Finnish nationwide study increased overall mortality in both CD and UC was observed. The excess mortality of 14% in IBD is mainly due to deaths related to inflammation in the gut.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Seinäjoki Central Hospital, Seinäjoki, Finland. Electronic address: airi.jussila@fimnet.fi.
authors.forename: Airi
authors.initials: A
authors.lastname: Jussila
authors.affiliation: Social Insurance Institution, Research Department, Turku, Finland.
authors.forename: Lauri J
authors.initials: LJ
authors.lastname: Virta
authors.affiliation: Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.affiliation: University of Helsinki, Helsinki, Finland; Department of Medicine, Institute of Clinical Medicine, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Martti A
authors.initials: MA
authors.lastname: Färkkilä
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D055815:Young Adult
keywords: Crohn's disease; Inflammatory bowel disease; Mortality; Registries; Ulcerative colitis