P179. Premature mortality and inflammatory bowel disease
A. O'Toole1, P. Walsh2, D. Keegan1, K. Byrne1, G. Doherty1, D. O'Donoghue1, H. Mulcahy1, 1St Vincent's University Hospital, Centre for colorectal disease, Dublin, Ireland, 2National Cancer Registry Ireland, Cork, Cork, Ireland
A number of studies have assessed survival in inflammatory bowel disease patients when compared with the general population, however, none has focussed on mortality in younger patients. Aim: To assess mortality in IBD patients under 65 years relative to the normal population and identify factors related to death in this age group.
We studied 2,570 IBD patients diagnosed before 65 years (mean age 32 years at diagnosis; 1265 male) attending a single tertiary referral centre between 1983 and 2012. Follow up was censored at 65 years and the overall follow-up included 22,965 patient years. 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 (for each year of follow-up). Expected survival (annual survival probability by single year of age) 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.
There were 52 deaths in the under 65 year old population, of which 40 were directly or indirectly related to inflammatory bowel disease. The 20 and 40 year relative survival rate for Crohn's disease patients was 97.7% and 77.4% respectively and for ulcerative colitis patients was 98.6% and 86.9%. An adjusted multivariate regression analysis of patients with Crohn's disease that included age, gender, disease site, surgery, presence of PSC and medication use identified PSC as the only predictor of premature mortality (p = 0.003). PSC was also identified as the only independent predictor of mortality in ulcerative colitis patients (p = 0.03).
20 year survival for both Crohn's disease and ulcerative colitis patients is similar to that of the general population, but 40 year mortality is excessive in both groups. The presence of PSC poses the greatest risk for mortality in both ulcerative colitis and Crohn's disease.