title: Mortality in inflammatory bowel disease patients under 65 years of age.
abstract: OBJECTIVE
  To assess mortality in inflammatory bowel disease (IBD) patients under 65 years of age and to identify the factors related to death in this age group. METHODS. We studied 2570 IBD patients who were diagnosed as having disease before 65 years of age and attended a single tertiary referral center area between 1983 and 2012. Follow-up was censored at 65 years. The causes of death were determined from death certificates obtained from the Irish registry office of births, marriages and deaths. Observed all-cause survival was compared with expected survival of persons of the same age and sex in the general population. Expected survival was obtained from national life tables produced by the central statistics office. Survival estimates were calculated for disease type, disease site, gender, the presence of primary sclerosing cholangitis (PSC), immunomodulator use, biologic therapy use, presence of fistulating disease and prior surgery.
  
  
  RESULTS
  Fifty-two deaths were reported in the population younger than 65 years, of which 41 were IBD related. We found little difference in survival in the first 25 years of follow-up, but relative survival decreased in both the Crohn's disease (CD) and ulcerative colitis (UC) cohort thereafter, so that 30-year mortality was excessive in both groups. An adjusted multivariate regression analysis of patients with CD identified PSC as the only predictor of premature mortality (p = 0.003). PSC was also identified as the only independent predictor of mortality in UC patients (p = 0.03).
  
  
  CONCLUSIONS
  The presence of PSC poses the greatest risk for mortality in both UC and CD.
authors.affiliation: Centre for Colorectal Diseases, St Vincent's University Hospital/University College Dublin (SVUH) , Elm Park, Dublin 4 , Ireland.
authors.forename: Aoibhlinn
authors.initials: A
authors.lastname: O'Toole
authors.forename: Paul
authors.initials: P
authors.lastname: Walsh
authors.forename: Denise
authors.initials: D
authors.lastname: Keegan
authors.forename: Kathryn
authors.initials: K
authors.lastname: Byrne
authors.forename: Glen
authors.initials: G
authors.lastname: Doherty
authors.forename: Diarmuid
authors.initials: D
authors.lastname: O'Donoghue
authors.forename: Hugh
authors.initials: H
authors.lastname: Mulcahy
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000401:mortality*; D007494:Ireland / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D055815:Young Adult
keywords: Crohn's disease; inflammatory bowel disease; mortality; primary sclerosing cholangitis; survival; ulcerative colitis