Childhood-onset inflammatory bowel diseases increase mortality risk
Patients with childhood-onset inflammatory bowel disease (IBD) are more likely to die than the general population, a study suggests.
Researchers identified 9,442 children with IBD (mean age at diagnosis, 13.7±3.5 years; 55.3 percent male) who were then matched for age, sex and place of residence to 93,180 general-population references. National death registries were used to obtain mortality data.
Over 138,690 person-years of follow-up, 294 deaths were reported in the childhood-onset cohort. The resulting rate (2.1 per 1,000 person-years) was higher than that in the matched reference individuals (940 deaths; 0.7 per 1,000 person-years). In absolute terms, this corresponded to one extra death per 694 childhood-onset IBD patients followed for 1 year.
Following the childhood-onset IBD patients through adulthood revealed a significantly higher likelihood of death relative to the matched general population (hazard ratio [HR], 3.2; 95 percent CI, 2.8–3.6). Analysis according to IBD type showed that this risk was highest in those with ulcerative colitis (HR, 4.0; 3.4–4.7; Crohn’s disease: HR, 2.3; 1.8–2.9).
Deaths were chiefly caused by cancer, which also conferred a sixfold higher risk of death (n=133; HR, 6.6; 5.3–8.2). Diseases of the digestive system, however, were the strongest mortality risk factor (n=54; HR, 36.8; 21.3–67.6).
Notably, the excess mortality associated with childhood-onset IBD remained significant even after >5 years of follow-up (HR, 3.3; 2.9–3.8), nor was it attenuated when analysis was restricted to patients who had been diagnosed after the introduction of biologic treatments.