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Increased Mortality of Patients With Childhood- Onset Inflammatory Bowel Diseases, Compared With the General Population
Sachs’ Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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2019 (English)In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 156, no 3, p. 614-622Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Childhood-onset inflammatory bowel disease (IBD) is believed to be a more severe disease than adultonset IBD, but there is little information on all-cause and causespecific mortality in patients with childhood-onset IBD. We performed a population-based cohort study, with 50 years of follow-up, to estimate absolute and relative risks for overall and cause-specific mortality in patients with childhood-onset IBD, during childhood and adulthood.

METHODS: We identified children with a diagnosis of IBD (younger than 18 years) in the Swedish nationwide health registers (1964-2014; n = 9442) and individuals from the general population matched for sex, age, calendar year, and place of residence (reference group; n = 93,180). Hazard ratios (HR) for death were estimated using Cox regression separately in patients with ulcerative colitis (n = 4671), Crohn's disease (n = 3780), and IBD unclassified (n = 991). HRs were compared among calendar periods.

RESULTS: During 138,690 person-years of follow-up, 294 deaths (2.1/1000 person-years) occurred among the patients with IBD compared with 940 deaths in the reference group (0.7/1000 person-years; adjusted HR, 3.2; 95% confidence interval [CI] 2.8-3.7). Mean age at end of follow-up was 30 years. HRs were increased for patients with ulcerative colitis 4.0, 95% CI 3.4-4.7; Crohn's disease 2.3, 95% CI 1.8-3.0; and IBD unclassified 2.0, 95% CI 1.2-3.4. Among patients younger than 18 years, there were 27 deaths from IBD 4.9, 95% CI 3.0-7.7. Among young adults with IBD, we found no evidence that HRs for death decreased from 1964 through 2014 (P = .90).

CONCLUSIONS: Children with IBD have a 3-fold increase in risk of death when followed through adulthood. The relative risk for death has not decreased with development of new drugs for treatment of IBD.

Place, publisher, year, edition, pages
Saunders Elsevier, 2019. Vol. 156, no 3, p. 614-622
Keywords [en]
Pediatric, Life Expectancy, Malignancy, Life Span
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-72526DOI: 10.1053/j.gastro.2018.10.028ISI: 000457714300024PubMedID: 30342031Scopus ID: 2-s2.0-85060985448OAI: oai:DiVA.org:oru-72526DiVA, id: diva2:1289890
Funder
The Karolinska Institutet's Research FoundationStockholm County CouncilSwedish Cancer SocietySwedish Research CouncilSwedish Foundation for Strategic Research
Note

Funding Agencies:

Swedish medical society (Ihre Foundation)

Mag-tarmfonden  

Jane and Dan Olsson Foundation  

Mjölkdroppen Foundation  

Bengt Ihre research fellowship in gastroenterology 

Available from: 2019-02-19 Created: 2019-02-19 Last updated: 2020-12-01Bibliographically approved

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Ludvigsson, Jonas F.

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